Huang Xing, Shan Shengzhou, Lu Lin, Jin Rui, Wang Xiuxia, Yuan Zhaoqi, Sun Di, Chang Mengling, Luo Xusong
From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine.
Department of Plastic and Reconstructive Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine.
Plast Reconstr Surg. 2025 Jan 1;155(1):141e-151e. doi: 10.1097/PRS.0000000000011434. Epub 2024 Mar 26.
Tissue expansion for treating giant congenital melanocytic nevi (GCMN) is a commonly used surgical method. However, the procedure's efficacy is often hindered by anatomical and histologic characteristics and blood supply, particularly in the extremities and trunk. Enhancing expansion efficiency while reducing complications is thus a topic to be investigated, especially for pediatric patients undergoing rapid physical and psychological development with higher risks of noncompliance to medical instructions. The purpose of this study was to explore the effectiveness of expansion in extremities and trunk by immobilizing the acellular dermal matrix (ADM) in the gravitational force zone of inflating expanders.
All patients involved in this research underwent ADM-assisted tissue expansion in either the extremities or trunk. ADM was fully flattened, securely fixed to the lower pole of the expander, and subsequently attached to the inner surface of the expanding flap.
From 2021 to 2023, a total of 9 pediatric patients with GCMN underwent ADM-assisted tissue expansion. All patients achieved the desired expansion volume without experiencing petechiae, ecchymosis, or skin ulceration in the ADM-covered area. The process was well tolerated by all patients, with no reports of itching, pain, allergic reaction, or fever. During the flap transfer, the ADM was observed to be firmly adhered to the expanding flap with discernible capillary network.
ADM-assisted tissue expansion demonstrates promise in augmenting expansion efficiency and reducing the time needed for surgical intervention in the extremities and trunk, thereby presenting significant clinical value for pediatric patients with GCMN.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
组织扩张术是治疗巨大先天性黑素细胞痣（GCMN）常用的手术方法。然而，该手术的疗效常受解剖学、组织学特征及血供的影响，尤其是在四肢和躯干部位。因此，提高扩张效率并减少并发症是一个有待研究的课题，对于正处于快速生理和心理发育阶段、不遵守医嘱风险较高的儿科患者而言尤为如此。本研究的目的是通过将脱细胞真皮基质（ADM）固定在膨胀扩张器的重力作用区，探讨在四肢和躯干进行扩张的有效性。
本研究纳入的所有患者均在四肢或躯干接受了ADM辅助组织扩张术。将ADM充分展平，牢固固定于扩张器的下极，随后附着于扩张皮瓣的内表面。
2021年至2023年，共有9例患有GCMN的儿科患者接受了ADM辅助组织扩张术。所有患者均达到了预期扩张体积，ADM覆盖区域未出现瘀点、瘀斑或皮肤溃疡。所有患者对该过程耐受性良好，未报告瘙痒、疼痛、过敏反应或发热。在皮瓣转移过程中，观察到ADM与扩张皮瓣紧密粘连，可见毛细血管网。
ADM辅助组织扩张术在提高四肢和躯干的扩张效率及减少手术干预所需时间方面显示出前景，从而为患有GCMN的儿科患者提供了显著的临床价值。
临床问题/证据级别：治疗性，IV级。
