皮肤扩张术在前胸部巨痣中乳头乳晕的处理方法

Treatment of nipple and areola in repeated skin soft tissue expansion which used in patients with anterior giant congenital melanocytic nevus

目的探讨采用皮肤软组织扩张器治疗前胸部先天性巨痣(giant congenital melanocytic nevus,GCMN)中乳头乳晕的处理方法及临床效果.方法自2017年1月至2021年9月,首都医科大学附属北京潞河医院整形外科收治4例前胸部巨痣患者,采用重复皮肤扩张术治疗,将乳头乳晕进行皮瓣下包埋、固定及乳头乳晕的定位,后期将乳头乳晕上方的皮肤作为整体进行再次扩张,直至扩张皮肤足量且巨痣可全部被切除,同时将乳头乳晕于皮瓣对应点切开后,进行乳晕周围缝合.结果4例患者前胸部黑痣完全切除,同时保留乳头乳晕,切口愈合后瘢痕隐蔽,外观可.结论对于前胸部巨痣的患者,在采用重复皮肤扩张术治疗过程中,将乳头乳晕进行暂时包埋,可减少乳头乳晕在皮肤软组织扩张过程中的干扰,最大面积的切除黑痣,完成前胸部巨痣完全切除,同时保留乳头乳晕,有效减少皮肤扩张次数及切口瘢痕,效果良好,值得临床推广及应用.

Objective To investigate the treatment method and clinical effect of nipple-areola in the treatment of giant congenital melanocytic nevus in anterior chest by repeated application of skin soft tissue expander,and to provide new ideas and surgical plans for the treatment of nipple-areola in the clinical treatment of anterior chest giant congenital melanocytic nevus.Methods From January 2017 to September 2021,4 patients,who treated in the Department of Plastic Surgery of Beijing Luhe Hospital Capital Medical University,with an-terior breast giant nevus were treated with repeated soft tissue expansion.The nipple and areola were embedded,fixed under the flap and positioned.Later,the skin above the nipple and areola was expanded again as a whole until the expanded skin was sufficient for the giant nevus were removed completely,and the nipple and areola were incised at the corresponding point of the skin flap,and then sutured around the areola.Results In this group of 4 cases,the treatment procedures of all patients were successfully,While the giant nevus on the front chest was completely removed,the nipple and areola were preserved.The scar was concealed after healing,and the appearance was accept-able.Conclusion In the treatment of giant nevus of the anterior chest with repeated skin expansion,temporarily embedding the nipple and areola can effectively reduce the number of expansions and incision scars.Because it can reduce the interference of nipple and areola in the process of skin soft tissue expansion,remove the nevus in the largest area,The effect is good and it is worthy of clinical promotion and application.