Solomon Santana S, Sitzman Thomas J
From the University of Arizona College of Medicine-Phoenix, Phoenix, Ariz.
Division of Plastic Surgery, Phoenix Children's Hospital, Phoenix, Ariz.
Plast Reconstr Surg Glob Open. 2023 Sep 29;11(9):e5299. doi: 10.1097/GOX.0000000000005299. eCollection 2023 Sep.
Tissue expansion with subsequent adjacent tissue transfer is often the preferred and sometimes the only option for reconstruction of large and giant congenital melanocytic nevi. Successful reconstruction with maximal efficiency and optimal aesthetic outcome requires careful planning of the tissue transfer, which itself requires careful selection of the tissue expander size and positioning. Unfortunately, there is little opportunity to gain experience in these skills due to the rarity of this condition. In situations where there is a rare condition that requires a complex technical procedure with much interoperative decision-making, surgical experience can be supplemented with the use of surgical simulation. In this article, we report on the use of three-dimensional patient imaging, three-dimensional printing, and surgical simulation for planning the reconstruction of large and giant congenital melanocytic nevi. We describe how this technology allows us to simulate multiple different approaches to expander placement and adjacent tissue transfer. We also describe how these simulations can be used to create cutting guides to guide final incision design and reduce intraoperative decision-making. Finally, we discuss how these models can be used to educate patients and families about the process and outcomes of nevus excision and reconstruction.
组织扩张并随后进行相邻组织转移通常是重建大型和巨大先天性黑素细胞痣的首选方法，有时也是唯一选择。要以最高效率和达到最佳美学效果成功进行重建，需要精心规划组织转移，而这本身又需要仔细选择组织扩张器的尺寸和位置。不幸的是，由于这种病症罕见，几乎没有机会积累这些技能的经验。在存在需要复杂技术程序且术中需做出诸多决策的罕见病症的情况下，手术经验可通过使用手术模拟来补充。在本文中，我们报告了使用三维患者成像、三维打印和手术模拟来规划大型和巨大先天性黑素细胞痣的重建。我们描述了这项技术如何使我们能够模拟多种不同的扩张器放置和相邻组织转移方法。我们还描述了这些模拟如何用于创建切割导板，以指导最终切口设计并减少术中决策。最后，我们讨论了这些模型如何用于向患者及其家属介绍痣切除和重建的过程及结果。
