皮肤软组织扩张术治疗先天性巨痣的应用及相关问题探讨

Discussion on application and related issues of skin soft tissue expansion in treatment of congenital giant nevus

目的探索应用皮肤软组织扩张术治疗先天性巨痣的临床效果。方法总结2010年7月至2019年9月收治的先天性巨痣患者28例,应用单次/多次头、躯干、四肢部位一期扩张后二期皮瓣进行修复。扩张器一期置入,当皮肤软组织充分扩张达预期目的时,取出扩张器,切除头面部、躯干、四肢部位巨痣,根据巨痣的大小、形状设计皮瓣,完全修复缺损。结果本组患者28例,巨痣面积约13 cm×12 cm~43 cm×33 cm,均予以全部切除。1例血肿、3例感染积极处理后好转,未影响皮瓣转移。术后随访6个月以上,皮瓣均成活良好且未见明显挛缩,颜色与周围正常皮肤相近,无复发。结论先天性巨痣通过皮肤软组织扩张术治疗后效果满意,值得推广。

Objective To summarize the curative effect of congenital giant nevus after transcutaneous soft tissue expansion.Methods In the past 9 years(July 2010 to September 2019),28 patients with congenital giant nevus were treated and repaired by single/multiple one-stage expansion of head,trunk and limbs followed by two-stage flap repair.The expander was placed in stage I,and when the skin and soft tissue were fully expanded,the expander was removed,and the giant nevus on the head,face,trunk and limbs was removed.Skin flaps were designed according to the size and shape of the giant nevus to completely repair the defect.Results In 28 cases,the area of giant nevus was about 13 cm×12 cm to 43 cm×33 cm,all of which were completely resected.One case of hematoma and three cases of infection were improved after active treatment,and the flap transfer was not affected.After follow-up for more than half a year,all the flaps survived well and no obvious contracture was observed.The color was similar to normal skin,and no recurrence was observed.Conclusion Congenital giant nevus treated by skin soft tissue expansion is satisfactory and worthy of promotion.