LAUSR

dHACM: dehydrated human amnion/chorion membrane allograft IH: infantile hemangioma PDGF: platelet-derived growth factor CASE REPORT We report the case of a 10-month-old girl with a large segmental ‘‘beard-distributed’’ infantile hemangioma (IH) with recalcitrant ulceration, successfully treated with dehydrated Human Amnion/ Chorion Membrane allograft (dHACM, EpiFix; MiMedx Group, Marietta, GA). The patient initially presented at 10 days of life with respiratory distress and was noted to have a segmental IH of the lower face and neck. Endoscopy confirmed involvement of the upper airway. Findings from a PHACE (posterior fossa malformations, hemangiomas, arterial anomalies, cardiac defects, eye abnormalities, sternal cleft, and supraumbilical raphe) workupwere normal. She was started on 0.5 mg/kg/d of propranolol, which was increased to 2 mg/kg/d over 48 hours. She was discharged home on a dose of 2 mg/kg/d, and the hemangioma proliferation appeared halted. However, despite continued therapy, she developed devastating ulceration and tissue destruction of the bilateral ears and lower lip 1 week after discharge. Her subsequent course was marked by severe, painful and recalcitrant ulceration. Multiple treatments were initiated to heal her ulcers, including propranolol (1-3 mg/kg/d), prednisone (1 mg/kg/d) in conjunction with low-dose propranolol (1 mg/kg/d), and trials of topical silvadene, over-the-counter zinc oxide, compounded zinc oxide 25% paste, becaplermin, collagen matrix dressing covered with Nu-derm (hydrocolloid