Yamashiro Toshifumi, Yoshida Momoko, Sato Junki, Azuma Ryuichi
Department of Plastic and Reconstructive Surgery, National Defense Medical College, Tokorozawa, JPN.
Cureus. 2024 Mar 10;16(3):e55920. doi: 10.7759/cureus.55920. eCollection 2024 Mar.
Tissue expansion is a handy reconstructive technique for the head and neck region; however, its implementation requires careful planning and surgical experience. If tissue expansion is inadequate, forced closure results in wound tension and risks complications, such as postoperative deformity, wide scarring, and wound dehiscence. We report a case of adult forehead melanocytic nevus excision using a tissue expander (TE) where complications caused by insufficient tissue expansion were avoided by creating a flap using a dog ear. The patient was a male in his 20s who underwent surgery with a TE for a congenital melanocytic nevus sized 15 × 10 cm on the left forehead. Resection was performed by tissue expansion using two TEs; however, simple advancement flaps led to excessive wound tension, risk of elevation of the eyebrow on the affected side, and postoperative scarring. Hence, a superficial temporal artery fasciocutaneous island flap with left superficial temporal vessels as a pedicle was raised at the dog ear and moved to the site of strong tension, and the wound was closed without difficulty. Although postoperative laser hair removal was required, both the appearance and functional results were satisfactory. Using anatomical flaps obtained from the surroundings during tissue expansion helps avoid complications associated with forced wound closure.
组织扩张术是一种用于头颈部区域的便捷重建技术；然而，其实施需要精心规划和手术经验。如果组织扩张不足，强行闭合会导致伤口张力增加，并存在术后畸形、广泛瘢痕形成和伤口裂开等并发症风险。我们报告了一例使用组织扩张器（TE）切除成人前额黑素细胞痣的病例，通过利用“狗耳”形成皮瓣避免了因组织扩张不足引起的并发症。患者为一名20多岁的男性，因左侧前额15×10 cm的先天性黑素细胞痣接受了使用TE的手术。使用两个TE通过组织扩张进行切除；然而，单纯推进皮瓣导致伤口张力过大、患侧眉毛上扬风险以及术后瘢痕形成。因此，在“狗耳”处掀起以左侧颞浅血管为蒂的颞浅动脉筋膜皮瓣岛状瓣，并转移至张力较大的部位，伤口顺利闭合。虽然术后需要进行激光脱毛，但外观和功能效果均令人满意。在组织扩张过程中利用从周围获取的解剖皮瓣有助于避免与强行伤口闭合相关的并发症。
