Wound closure and gradual involution of an infantile hemangioma using a noncontact, low-frequency ultrasound therapy

Facial hemangiomas are benign vascular neoplasms of infancy and childhood. Although most hemangiomas do not result in significant complications, some result in pain, ulceration, infection, and structural abnormalities and can interfere with respiration, vision, and hearing. A 5-month-old infant presented to the author's wound center with a necrotic wound within a large, segmental hemangioma of mixed superficial and deep morphology; her vision was obstructed. The patient's discomfort was indicated by poor feeding and irritability. The hemangioma had been treated with oral corticosteroids and laser therapy. The wound within had been treated with povidone-iodine, moist healing, and topical growth factors. Debridement of necrotic tissue was indicated at presentation; however, bleeding and discomfort were risks. Daily noncontact, low-frequency ultrasound (used for painless debridement of chronic wounds) was initiated to remove necrotic tissue and prepare the wound for grafting. By day 8 of this treatment, the wound bed was covered with healthy-appearing granulation tissue and epithelialization had begun. Additionally, the hemangioma began to involute. Laser treatments were discontinued and the patient was weaned from oral steroids. By week 7, the wound was completely closed and did not require skin grafting. The hemangioma continued to involute. Additional studies are warranted to elucidate the role of noncontact, low-frequency ultrasound in the management of ulcerated hemangioma.