ULCER CARE INSTRUCTIONS
By Gregory Levitin, MD and Carrie Smith, LPN
Ulceration of Infantile hemangiomas occurs in up to 15% of patients.
Ulcerations cause significant pain and put the patient at risk for infection.
This publication is written as a resource for the care of ulcerated
The National Organization of Vascular Anomalies and the Vascular Birthmark Foundation
has approved this information as supplemental information for the care of ulcerated
hemangiomas. Please discuss this document with your physician.
Treating an ulcerated hemangioma is a very challenging task. It can be physically and
emotionally hard for both you and your child. Please remember that you are helping your
child. If you do not do this, your child can develop a wound infection and the ulceration will
FREQUENCY: You should clean and change the dressing for your child’s ulcer ____times
* In some cases, your doctor may recommend giving your child pain medication _____minutes
prior to the wound care. NOTE: This will not make the dressing change pain free, just less
painful. If your child has little or no pain, you may not need to give any medication.
PREPARATION: Wash your hands thoroughly. Gather all supplies that will be needed and
assemble in an accessible area. Put gloves on prior to opening any sterile materials that will
touch the wound.
CLEANING: To effectively clean the area, first wet the area with saline or sterile water.
Using your fingertips use a gentle skin cleanser to slowly wash only the superficial layer of the
ulceration. Do not try to scrub off any debris as this may cause bleeding. Rinse the area by
either gently patting the wound with a wet gauze, or by dripping saline or sterile water over the
After the area is cleansed, you will need to pat the area dry. Use a gauze pad or a clean, dry
WOUND DRESSING: You may or may not need to cover the ulceratation. If you do not
need to cover the area, you are done! Clean up your supplies and wash your hands. If you do
need the cover the area please do so in the following manner:
1. For wet-to-dry dressing care, choose an appropriately sized gauze dressing that will most
adequately cover the ulcerated area. First dampen the gauze with saline or sterile water and
squeeze out any excess.
2. Unfold the dressing and gently lay it over the entire ulceration so all exposed areas are now
3. If your doctor recommends an ointment, then use a gloved hand or Q-tip to apply a uniform
layer over the ulcerated area. Remember that more is not necessarily better! A thin layer is all
that you need unless otherwise instructed.
OUTER DRESSING: For the outer layer cover
1. For wet-to-dry dressing care, cover the wet gauze dressing with an equal sized dry gauze
2. If your doctor recommends a non-stick dressing, apply directly over the ulceration.
TAPE: to keep the dressing intact, cover the dressing with a generous piece of tape; this
should adequately cover the dressing with an ample area to adhere to the skin. A good rule of
thumb is to use a piece of tape that is twice as long as the bandage ( i.e. to cover a 4 x 4 gauze,
use an 8 inch long piece of tape).
WHAT TO LOOK FOR: Watch for any signs of infections and bleeding. If you notice
colorful drainage, foul odor, surrounding redness or anything unusual, please call your doctor
BLEEDING: If your child’s ulcer begins to bleed, apply direct pressure with a gauze pad for
______ minutes to stop the bleeding. No peeking! If it is still bleeding after _____ minutes,
call your doctor immediately or go to your local emergency room.
*This information is in no way intended to preclude any medical treatment your physician has prescribed for the
management of an ulcerated hemangioma, but these suggestions have been helpful for many parents of children
with ulcerated hemangiomas.
For More information contact
The Vascular Birthmark Foundation
PO Box 106 Latham, NY 12110
National Organization of Vascular Anomalies
8711 – 104 Six Forks Road PMB 126 Raleigh NC 27614
Supplies needed to properly care for your child’s ulcer
_____ Tape (2 inch paper tape is best)
_____ Gauze Pads (2x2 as well as 4x 4)
_____ Dressing to directly cover the ulcerated area. (An Adaptic dressing by Johnson and
Johnson is a non-stick dressing that can be used very effectively. You will need to
cover this with a different type of gauze-type dressing since tape will not stick
_____ Skin Cleanser (liquid Cetaphil)
_____ Water (Bottled sterile saline or sterile water. Do not use tap water.)
_____ Pain medication- This can reduce pain but will not eliminate it. There are many
side effects to pain medications, so use only if necessary. Your child will cry
regardless of taking pain medication or not.
_____ Topical medication if ordered by your child’s doctor. (example: Regranex)
_____ Ointment- Use only if ordered by your child’s doctor. You should only apply this
to dry / scaly areas on the hemangioma, or on mild / superficial ulcerations. Use
only on affected areas, as continual use can cause surrounding skin to break down
further. The most common recommended ointments are Aquafor and Bacitracin.
You can purchase most of these supplies at your local pharmacy. You may need to contact
your local home medical supply company as well if you are having trouble finding the items