Surgical treatment of head and neck port-wine stains by means of a staged zonal approach

Background: The majority of patients with capillary malformations (port-wine stains) develop soft-tissue and bony hypertrophy leading to gross facial asymmetry and functional deficits in vision, breathing, speech, and feeding. The authors describe and illustrate a surgical approach for the treatment of these malformations with restoration of facial symmetry and contour based on facial subunits. Methods: The authors conducted a retrospective case series of patients from 2004 to 2011 presenting for primary evaluation and treatment to a tertiary referral center specializing in vascular anomalies. The medical records and photographs of patients with facial capillary malformations and soft-tissue hypertrophy were reviewed. Results: Of the 160 patients who presented with the diagnosis of facial capillary malformation/port-wine stain, 96 (60 percent) had soft-tissue hypertrophy in one or more dermatomes resulting in facial asymmetry. Only 4.4 percent of patients had solely V₁ involvement, 38.8 percent had V₂ involvement, and 15.6 percent had V₃ involvement. The technique and incisions used for each facial zone are described in detail. In all cases, incisions were placed along existing boundaries of facial subunits. Serial pulsed-dye laser treatments were also performed. Conclusions: Sixty percent of patients with facial capillary malformation experience soft-tissue hypertrophy with or without bony remodeling, and surgical correction is required. The authors describe a staged surgical treatment for these patients based on a subunit and zonal approach to the face.