Often the vascular skin lesions are broadly grouped into 2 varieties based on its presentation and its pathology.

Vascular malformations: Birth marks that are present since birth . Patch of any colour other than black on any part of the skin or mucosa present at or within days after birth. These vascular malformations are variable in its manifestation depending on whether its a low flow or high flow vascular malformation.

1) Low flow: Slow growing or static. Usually a cosmetic issue than any thing else. Birthmarks of this nature are easily manageable with various properly selected LASERs.

2) High flow: Progressive vascular lesions often with worsening symptoms such as swelling, pain, overgrowth of the part and beyond, pressure on the neighboring structures, high output cardiac failure etc. Often what is seen on the surface is tip of the iceberg with unpredictable deeper extent. Hence these high flow vascular malformations require detailed imaging investigations such CT Angio/MRA etc to study the extent, type and feeding vessels. The management is often complex and requires input from interventional radiologist before surgical removal. Due to extensive nature of this condition, the removal is often incomplete in order to preserve the blood supply to the extremities. This is one of the reasons why they sometimes recur later.

Haemangiomas: Plumply vascular lesion which appear as a pinkish patch initially few weeks after birth. This vascular birth mark has a peculiar growth cycle and spontaneous resolution in majority of the cases. That means majority of them require none other than supervision by experts in dealing with these birth marks. These lesions keep growing until the child is around 3 years followed by the phase of spontaneous resolution of about 70% by 7years. Occasionally residual redundant skin requires tidying up. In minority of symptomatic cases as a result of pressure from rapidly growing haemangioma in the vicinity of important parts such eyes, close monitoring by paediatrician with or with out surgical intervention is required. Otherwise it may result in some irreversible damage such as blindness.

Clefts are birth defects on the face, generally the upper lip and palate. these defects are usually vertical slits of variable extent and associated with a range of nose or other facial deformities.

Children born with cleft lip and palate in isolation or in combination poses the eagerly awaiting parents with emotional distress, a sense of guilt and many questions. In the ideal world, it is diagnosed during pregnancy and the parents are given proper counselling. The counselling aims at educating the parents regarding these congenital defects, their incidence, modern management programme that makes these unfortunate babies into nearly normal individuals.

These babies are better managed by a well co-ordinated multidisciplinary team (MDT) of specialists that includes Paediatrician, Plastic Surgeon, Orthodontist, Speech therapist etc co-ordinated by a cleft care nurse. With this approach, one can expect the best outcome and experience in restoring normalcy.

Babies born with abnormal shaped head, which sometimes get worse unless intervened and some of them get better without any intervention. But the key is to identify those who need intervention in order to take them through a timely procedure to restore the shape, to prevent potential damage to brain and eyes by relieving undue pressure and exposure.

This again demands a well co-ordinated team of specialists which includes the team similar to cleft care, in addition, a Neurologist and Neurosurgeon are to be involved as a part of the MDT.

Some of these children do present with anomalies in the hand as a part of the Syndrome. The correction procedures on the affected hand are timed usually in the preschool age.

They are rare but most disturbing for parents and difficult for treating doctors. Chest wall defects are much rarer than Abdominal ones. The Abdominal wall defects are again grouped into two major types, Gastroschisis and Omphalocele/Exomphalos. They can be minor or major depending the on the proportion of the defect. The minor ones are suitable for direct surgical closure without delay, Where as the major omphloceles requires special techniques to expand the abdominal wall to accommodate all the abdominal contents before the surgical closure can be achieved.

Because these are rare, the parents and family friends of these unfortunate babies have joined together in the net as a forum to share the experience and to support the future victims. You can find them on http://geeps.forumsplace.com.

The hand and upper limb develops into full shape within a period 3-4weeks time during the later part of the 1st trimester of the pregnancy.

Any disturbance to this process could result in some kind of anomaly. The list of these hand anomalies run into pages in the textbooks. But the common ones are extra fingers, fused fingers, underdeveloped or absent thumb/fingers. Most complex ones are when the deformity affecting the whole hand and extending to the remaining parts of the upper limb to various degrees as in Radial & Ulnar Club hands. These complex anomalies require multiple staged procedures which are properly timed to restore the shape and its function.
Finally, extremely rare condition where the hand is completely absent at any level below the shoulder. There are only two options, 1) Hand transplant(rare & many conditions apply). 2) Prosthesis (Currant practice).

Phimosis: Commonest of all anomalies. Pinhole opening of the foreskin of the penis is called Phimosis. This is treated either by Circumcision or Prepucioplasty where in the foreskin is adequately preserved while increasing the opening.

Hypospadias: One of the Common genital anomalies is hypospadias. The diagnosis of Hypospadias is made when the baby is born with a urinary passage opening at an abnormal location undersurface of the penis. The severity of hypospadias is directly depends on how far is it away from the tip of the Penis. Further the severe. It is often associated with Chordee. The penis that bends down upon erection is called called Chordee. The objectives of treating Hypospadias includes 1) Relocating the opening to the tip of the penis, 2) Straight penis upon erection and 3)Minimal scarring.

Epispadias: This is opposite of hypospadias and rarer. The abnormal opening is on the upper surface of the penis. The treatment is based on the same principles as for Hypospadias.

Extrophy of Bladder: This is very rare and considered to be severe degree of epispadias. This includes both external and internal anomalies where in the urinary bladder is open to the exterior in the lower abdomen via the unfused wide pubic bones. This requires staged procedures by a team of Plastic, Orthopaedic and Paediatric surgeons to achieve optimal results.

Vaginal Atresia: Absent or poorly developed Vagina. The reconstruction of Vagina can be achieved by various techniques ranging from skin grafts to free flaps which are chosen on individual basis. This is usually timed only in adulthood usually requires element of cooperation from the prospective sexual partner/Husband.