The majority of hemangiomas can be excised at some point during the shrinkage phase, prior to complete involution. At this point there is no further growth, but there is still active circulation through the residual hemangioma vessels. If it is determined that unsatisfactory shrinkage is likely to occur, and if the operation can be done safely with acceptable blood loss, then surgical excision can be considered. In many cases, the boundaries of the hemangioma are well-defined, there is adequate adjacent skin laxity for closure, and the hemangioma can be excised with minimal blood loss by staying peripheral to it (Fig 9) . Pedunculated hemangiomas can often be excised with a reasonably short scar. Hemangiomas with both a central dermal component and a peripheral subcutaneous component can usually be incised just peripheral to the central part, and then the entire hemangioma removed through the central opening.
Intramuscular (IM) Injection Procedure
It is optimal for an intramuscular injection to have in possession syringes without the tips (needles) already affixed to them. Preferably, the individual should have the hermetically sealed syringes (barrels) separate from the hermetically sealed needle tips. Although one can easily use syringes with the tips already affixed, it is slightly more complicated and adds an extra step or two into the process that otherwise would not be there. So, every individual should ensure to the best of their ability to have the syringe and needle tips separate. The following is a list of required items for intramuscular injections :