Shachar Yair, Billig Allan, Chapchay Katya, Elia Jhonatan, Adler Neta, Margulis Alexander
Department of Plastic, Reconstructive, and Hand Surgery, Hadassah University Medical Center, Jerusalem, Israel.
Department of Plastic, Reconstructive, and Hand Surgery, Hadassah University Medical Center, Jerusalem, Israel.
J Plast Reconstr Aesthet Surg. 2016 Dec;69(12):1676-1682. doi: 10.1016/j.bjps.2016.08.024. Epub 2016 Oct 5.
Large congenital melanocytic nevi entail significant medical and cosmetic ramifications for patients and families. Reconstruction is a challenging endeavor, especially when the lesion is present on the limbs. The literature describes various methods by which a plastic surgeon can address reconstruction; yet, to date, there has been no series describing a method that provides consistent results with low complication rates. In this study, we describe our surgical technique for reconstruction of the upper extremity after excision of large circumferential CNM with a pre-expanded bi-pedicled flap, namely the "sleeve" flap.
A systematic review of our database of pediatric patients treated for large and giant nevi was performed. Patients with large and giant circumferential upper extremity nevi were retrieved, and their charts reviewed for demographics, number of procedures performed, duration of follow-up, and complications.
Over a course of 12 years, eight patients with large or giant circumferential nevi of the upper extremity were treated at our institution with "sleeve" flap reconstruction. Mean follow-up time was 36 months. A single complication was seen. All reconstructions achieved satisfactory results, both functionally and cosmetically.
We describe our surgical approach for treating upper extremity large and giant circumferential nevi with pre-expanded bi-pedicled "sleeve" flaps. When properly planned and executed, this technique enables successful treatment of large and giant nevi of the arm and the forearm. Although arduous and complex, the process yields excellent aesthetic results with low complication rates. This technique is promising as the reconstructive option of choice for these difficult lesions.
巨大先天性黑素细胞痣给患者及其家庭带来了重大的医学和美容方面的影响。重建手术是一项具有挑战性的工作，尤其是当病变出现在四肢时。文献中描述了整形外科医生进行重建的各种方法；然而，迄今为止，尚无系列报道描述一种能产生一致结果且并发症发生率低的方法。在本研究中，我们描述了一种使用预先扩张的双蒂皮瓣，即“袖状”皮瓣，在切除上肢巨大环状先天性黑素细胞痣后进行重建的手术技术。
对我们治疗大痣和巨痣的儿科患者数据库进行了系统回顾。检索患有上肢巨大环状痣的患者，并查阅他们的病历以获取人口统计学信息、进行的手术次数、随访时间和并发症情况。
在12年的时间里，我们机构对8例上肢巨大或巨型环状痣患者进行了“袖状”皮瓣重建治疗。平均随访时间为36个月。仅出现了1例并发症。所有重建在功能和美容方面均取得了满意的效果。
我们描述了使用预先扩张的双蒂“袖状”皮瓣治疗上肢巨大和巨型环状痣的手术方法。如果规划和执行得当，该技术能够成功治疗上臂和前臂的巨大和巨型痣。尽管该过程艰巨且复杂，但能产生极佳的美学效果且并发症发生率低。作为这些疑难病变的重建选择，该技术很有前景。
