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Introduction:  External angular dermoid cysts, or epidermoid inclusion cysts, are a common subcutaneous tumor of the head and neck. For the majority of these lesions, excision is relatively simple and performed through an incision immediately overlying the mass. Facial lesions in pediatric patients present a unique challenge in that a direct approach carries the potential for visible scar formation.Objective:  This article aims to detail our experience with subcutaneoscopic excision of external angular dermoid cysts in pediatric patients using endoscopic instrumentation.Materials and Methods:  Retrospectively, we reviewed 11 cases, between the ages of 4 months and 3 years with external angular dermoid cysts. An incision is made on the scalp above the hairline, then a tunneled working space is created underneath the skin. 3 mm laparoscopy instruments were then used for providing excellent visualization and precise subcutaneoscopic dissection.Results:  There were no complications apparent in any of the 11 cases (except cyst rupture in one case), with mean procedure duration at 61 minutes. Final results at follow-up revealed aesthetically pleasing and well-healed skin incisions, hidden from view behind the hairline.Conclusion:  The subcutaneoscopic technique utilizing endoscopic instrumentation has the advantage of improved visualization of the cyst, greater precision of dissection, and excellent cosmesis. One disadvantage of this procedure is that this involves learning a new technique while the majority of surgeons are already comfortable with the open approach. Given the safety and efficacy observed for this subcutaneoscopic procedure, this technique can have tremendous possibilities. [ABSTRACT FROM AUTHOR]

Children with vascularmalformations are bestmanaged with amultidisciplinary teamof specialists. Interventional radiology may deliver primary treatment such as staged sclerotherapy and embolization for malformations that are poor candidates for primary surgical resection or play a supportive role such as preoperative or intraoperative embolization. A thorough understanding of vascular morphology and flow dynamics is imperative to choosing the best treatment tool and technique. In this review, the author discusses the selection of techniques and tools used to treat vascular malformations based on their angiographic morphology. [ABSTRACT FROM AUTHOR]

Vascular anomalies (VAs) comprise a large variety of individual diagnoses that in different phases of treatment require a diverse number ofmedical specialists to provide optimal care. Medical therapies include agents usually associated with cancer chemotherapy, such as vincristine, as well more immunomodulatory types of drugs, such as glucocorticoids and sirolimus. These immunomodulating drugs are being successfully applied in cases that are typically categorized as vascular tumors, including kaposiform hemangioendothelioma (KHE) and tufted angioma (TA), as well as some of the more invasive types of vascularmalformations (i.e., microcystic lymphatic malformations and blue rubber bleb nevus syndrome (BRBNS). These therapies need to be combined with good supportive care, which often involves anticoagulation, antimicrobial prophylaxis, and comprehensive pain and symptom-relief strategies, as well as appropriate drug monitoring and management of side effects of medical treatment. The optimal care of these patients frequently involves close collaboration between surgeons, interventional and conventional radiologists, medical subspecialists, and nurses. [ABSTRACT FROM AUTHOR]

Primary suture-less closure of gastroschisis using negative pressure dressing (wound vacuum) involves the application of an initial preformed Silo with subsequent bedside suture-less closure of the defect using negative pressure dressing. The advantages of this gentle approach are the simple bedside closure without intubation, paralysis or ventilation as well as reduced risk of barotrauma, abdominal compartment syndrome, acidosis, bowel infarction and necrotizing enterocolitis. This study is a report of the technique we used for gastroschisis closure at our institute.The medical records of 15 newborns who underwent primary suture-less closure of gastroschisis using a negative pressure dressing (wound vacuum) technique between March 2008 and February 2010 were retrospectively reviewed. Outcome criteria such as time on ventilation, time to initiating feeds, time to full feeds, time to discharge from NICU and complications were recorded.The median follow-up was 234 days (range: 13–528 days). The time on ventilation was (n=8: no ventilation; n=3: 1 day; n=2: 2–5 days; n=2:>5 days). The median time to initiating feeds was 13 days (range: 6–61 days), the median time to full feeds was 20 days (range: 12–91 days) and the median time to discharge was 24 days (range: 21–131 days). 2 patients had a tiny umbilical hernia at last follow-up.Primary suture-less closure of gastroschisis using a negative pressure dressing (wound vacuum) technique is easily reversible, does not need intubation/ventilation, avoids a trip to the operating room (OR), has minimal to no complications and provides good cosmetic results. [ABSTRACT FROM AUTHOR]