Serial expansion without delay for the treatment of giant congenital melanocytic nevi on the back
10.3760/cma.j.cn114453-20210502-00195
- VernacularTitle:连续组织扩张术治疗背部巨型先天性黑色素细胞痣
- Author:
Zhiguo SU
1
;
Hongbo CHEN
;
Jincai FAN
;
Liqiang LIU
;
Jia TIAN
Author Information
1. 中国医学科学院北京协和医学院整形外科医院整形九科，北京 100144
- Keywords:
Nevus, pigmented;
Tissue expansion;
Congenital;
Back;
Therapeutics
- From:
Chinese Journal of Plastic Surgery
2022;38(11):1243-1248
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the safety and efficacy of serial expansion without delay for the treatment of giant congenital melanocytic nevi (GCMN) on the back.Methods:The clinical date of children with GCMN on the back admitted to the Ninth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from February 2017 to March 2019 were retrospectively analyzed. In stage Ⅰ, an expander was placed on each side of the back to laterally expand the skin on the back, as a whole. In stage Ⅱ, after the expanders were removed and part of the nevus was removed, the expanded flaps were advanced integrally across the back with additional incisions on both sides of the trunk. The new expanders were then placed under the expanded flaps simultaneously for serial expansion. In stage Ⅲ, the expanded flaps were used to reconstruct the wound after resection of GCMN. The color, texture of the flaps and the postoperative scar on the back were observed.Results:Ten patients were enrolled, including 4 males and 6 females, with an average age of 3.4 years (ranged between 2-6 years). All patients completed three stages of treatment. In the second stage, new expanders were placed under the expanded flap for serial expansion simultaneously. The three-stage operation took a total of 6.80 to 11.77 months, and all the nevus on the back were removed. The mean follow-up time was 16.6 months (ranged between 12-24 months). In one case, the skin flap necrosis (1.5 cm × 1.2 cm) was caused by abrasion at the end of stage Ⅱ when the inflation of the expander was nearly completed, without exposure of the dilator. After the expanders were removed in stage Ⅲ, the flap survived well. In the other children, no wound dehiscence, infection, dilator exposure and other complications occurred. The back was maintained as a whole aesthetic unit without conspicuous scars and the postoperative scars were located on the sides of the trunk. The color and texture of the flap were similar to its surrounding tissue.Conclusions:Serial expansion without delay is safe and efficient in the treatment of GCMN on the back. It not only eliminates the need to wait 4 to 15 months for the expander implantation, but also saves one operation and anesthesia. During the treatment, additional incisions are only made on both sides of the trunk, which could maintain the back as a whole aesthetic unit and obtain a better postoperative appearance.
