Cleaning and dressing ulcerated haemangiomas

This information sheet explains how you can clean and dress an ulcerated haemangioma to promote healing and reduce pain. Brand names for certain dressings used at Great Ormond Street Hospital (GOSH) are mentioned in this information sheet – including brand names does not mean they are recommended by GOSH and in many cases, alternative dressings will be available.

• Always have the dressing and cleaning solution prepared before removing the old dressing.
• When removing a dressing, if it is stuck, do not remove it forcibly – soak it off gradually. If bleeding occurs at any time during a dressing change, apply pressure using gauze for five minutes without looking and secure in place. If blood soaks through the gauze, do not remove it but add more gauze on top. Leave the gauze in place for 48 hours. If at all concerned, take your child to the nearest Accident and Emergency (A&E) department.

You will need:

• Antimicrobial or antibiotic ointment
• Non-adherent silicone dressing of appropriate size – such as Adaptic®Touch
• Alginate dressings or similar of appropriate size – such as Sorbsan® Flat or Kaltostat®
• Soft sterile gauze
• Cotton bandages or adhesive tape – such as Mepitac®
• Plaster tape – such as Elastoplast®
• Cooled boiled water , saline solution or sterile water – do not use tap water
• Oil based cleansing solution to use as a soak, pour or bath as required – such as Dermol® 600
• Stretchy tubular bandage to secure dressing – such as Tubifast® - ready-made vests and balaclavas are available

1. Prepare the dressing by laying several pieces of gauze on a sterile surface – such as the inside of one of the dressings pack
2. Put the alginate dressing on top of the gauze 
3. Open the non-adherent silicone dressing and cut to size
4. Remove the plastic covering on one side
5. Apply a layer of ointment large enough to cover the ulceration directly to the surface of the dressing
6. Remove the plastic covering on the other side and place dressing ointment side upwards on top of the alginate dressing
7. You should now have three different dressings layered together with the ointment ready to put directly on the ulcerated area
8. Clean the ulcerated area with cooled, boiled water or saline by pouring the solution slowly over the area
9. Alternatively, fill a baby bath with warm water and add the oil based cleansing solution according to the instructions on the bottle
10. Bathe your baby for 10 to 15 minutes allowing the dressing to soak off gently
11. If the dressing is stuck, soak it off gently – do not pull it off 
12. When the dressing has been removed and the area has been soaked with the water, leave it to dry naturally – do not towel dry the ulcerated area
13. When the area is dry, apply the prepared dressing, making sure that the ointment is covering the ulceration
14. Secure the dressing in place using the cotton bandage or adhesive tape and/or use the tubular bandage and/or tape to keep the dressing secure.

You will need:

• Antimicrobial or antibiotic ointment
• Non-adherent silicone dressing of appropriate size – such as Adaptic®Touch
• Alginate dressing – such as Sorbsan® Flat – or similar of appropriate size
• Soft sterile gauz
• Cooled boiled water, saline solution or sterile water – do not use tap water
• Oil based cleansing solution to use as a soak, pour or bath as required – such as Dermol® 600
• Moisturising ointment – such as Diprobase® ointment – petroleum jelly – such as Vaseline®

1. Prepare the dressing by laying several pieces of gauze on a sterile surface – such as the inside of one of the dressings pack
2. Put the alginate dressing on top of the gauze
3. Open the non-adherent silicone dressing and cut to size – it should be at least twice the size of the ulcer
4. Remove the plastic covering on one side
5. Apply a layer of ointment large enough to cover the ulceration directly to the surface of the dressing
6. Remove the plastic covering on the other side and place dressing ointment side upwards on top of the alginate dressing
7. You should now have three different dressings layered together with the ointment ready to put directly on the ulcerated area
8. Clean the ulcerated area with water or saline by pouring the solution slowly over the area
9. Alternatively, fill a baby bath with warm water and add the oil based cleansing solution according to the instructions on the bottle
10. Bathe your baby for 10 to 15 minutes allowing the dressing to soak off gently
11. If the dressing is stuck, soak it off gently – do not pull it off
12. When the dressing has been removed and the area has been soaked with the water, leave it to dry naturally – do not towel dry the ulcerated area
13. When the area is dry, apply the prepared dressing, making sure that the ointment is covering the ulceration
14. Put on a nappy to keep the dressing in place 15. You are likely to need to repeat this dressing with every nappy change, but only use the antimicrobial or antibiotic ointment twice a day. For other dressings, use the moisturising ointment (not cream) or petroleum jelly instead.