Chrétien-Marquet B, Bennaceur S, Fernandez R
Department of Plastic and Reconstructive Surgery, Hôpital Necker Enfants-Malades, Paris, France.
Plast Reconstr Surg. 1997 Sep;100(4):926-36. doi: 10.1097/00006534-199709001-00015.
Excision of large cutaneous lesions of the back, such as giant nevi in children, represents a major surgical challenge. Actually, many authors use tissue expanders. Recently, we have proposed, through a better evaluation of the biomechanical properties of the skin, a natural expansion mode using the postoperative tension. This expansion is natural and delayed. In the back the natural expansion can be created by concentric excision, which takes maximum advantage of the possibilities of cutaneous mobilization of the back. The concentric excision has been used in 12 children presenting with cutaneous lesions of the back involving more than 30 percent of the dorsal anatomic unit. Nine patients underwent total excision; two patients were treated in one stage, four patients in two stages, and three patients in three stages. Three patients could not have total excision. The follow-up was uneventful, except in one patient who presented with wound dehiscence. The follow-up was 1 to 2 years and showed a modest scar widening (< 4 mm) in three patients, moderate widening (> 4 min, < 7 mm) in three patients, and significant widening (> 10 mm) in three patients. The systematization of the cutaneous mobilization for each region of the back has allowed us to optimize the utilization of peripheral normal tissue in the surgical treatment of large cutaneous lesions of the back. In some circumstances, the gain in tissue has been superior to that we usually obtain with skin expanders and with lesser cost, lesser pain, and fewer risks.
切除背部大面积皮肤病变，如儿童的巨大痣，是一项重大的外科挑战。实际上，许多作者使用组织扩张器。最近，通过对皮肤生物力学特性的更好评估，我们提出了一种利用术后张力的自然扩张模式。这种扩张是自然且延迟的。在背部，自然扩张可通过同心切除来实现，其最大限度地利用了背部皮肤活动的可能性。同心切除已应用于12例背部皮肤病变累及超过30%背部解剖单元的儿童患者。9例患者接受了全切；2例患者一期治疗，4例患者分两期治疗，3例患者分三期治疗。3例患者无法进行全切。除1例出现伤口裂开的患者外，随访过程顺利。随访时间为1至2年，结果显示3例患者瘢痕轻度增宽（<4mm），3例患者中度增宽（>4mm，<7mm），3例患者显著增宽（>10mm）。对背部每个区域的皮肤活动进行系统化处理，使我们能够在背部大面积皮肤病变的外科治疗中优化周边正常组织的利用。在某些情况下，获得的组织量优于我们通常使用皮肤扩张器时获得的量，且成本更低、疼痛更少、风险更小。
