| Objective:Melanocytic nevi is a common and discosmetic benign skin neoplasm, which can be distributed throughout the body, but 70%-90%tend to appear face. Looks and psychological effects on the human body is great,so the facial aesthetics repair is of crucial importance.By comparing the method and clinical effect of skin tissue expansion with free skin transplantation in the treatment of giant facial melanocytic, we try to analyze the advantages and disadvantages of two surgical methods.Methods:134 patients with more than 25% of facial region melanocytic nevi, were treated in the Second Affiliated Hospital of Kunming Medical University Plastic Surgery department from February 2005 to February 2015, and underwent the flap transfer or free skin transplantation by application of implanted expander in order to repair facial secondary wounds after the melanocytic nevi resection were retrospectively studied. In the 137 cases, there were 53 male cases,81 female cases, ageing from 6 to 43 years old, among which the minimum age was 6, the maximum age was 43, mean age was 17.The patients were divided into two groups, free skin transplantation group (36 cases)and skin expansion group(98 cases). Meanwhile, we made a summary in terms of efficacy, complication and the satisfaction of patient. Based on the measurement of the wound excision lesion size, the free skin transplantation group were cut relevant area medium thickness skin grafts which were implanted into secondary wounds. The operation of skin tissue expansion group was divided into 2～3 phases. Phase I:According to the facial melanocytic nevi location and size, the prepared 50-400ml kidney-shaped or cylindrical expanders were implanted in face, forehead, deltopectoral and medial upper arm area. Then in the following week, every expander were injected water to expand the flap. Phase Ⅱ:Making use of the excess skin after skin expansion designed sliding flap, rotation flap or ectopic flaps to repair the secondary wounds. Phase Ⅲ:A month later, the cases which were applied deltopectoral, medial upper arm expansion thoracic flap, proceeded skin flap pedicle division to repair the residual lesions. In the free skin graft group, according to the measurement of excision wound size of the lesion, the dermatome were used in skin donor site to obtain the corresponding area of thick skin graft, which to repair the secondary wound.Results:Each case was follow-up visited including cosmetic effects, with or without recurrence, scar and pigmentation by the means of clinic, telephone and so on after operation from 3 months to 2 years. The skin expansion group had 3 cases of exposure of expander (4.47%),2 cases of infection (2.98%) and 2 cases of hematoma (2.98%). After phase Ⅱ operation, there were 1 case of infection (1.49%) and 2 cases of distal flap epidermal necrosis with remarkable scar(2.98%). In this group, low recurrence rate, almost normal sense, texture and color, less noticeable scar and no pigmentation were observed. The free skin transplantation group had 2 cases of infection (2.98%),4 cases of hematoma (5.97%) and 1 case of dissolved skin phenomenon(1.49%). Although the recurrence rate of free skin graft group was low, the satisfaction of surgery effect was poor because of different degrees of pigmentation, skin contracture and ring-shaped scar.Conclusion:There are no donor area damage, no new scars and deformities and the almost normal sense, texture and color after the treatment of the skin expansion of giant facial melanocytic nevi. Although this method takes a longer time, times of operation, and the cost is more expensive than free skin grafting, but the postoperative appearance, prognosis and satisfaction are better. Therefore, application of skin soft tissue expansion technique in the treatment of pigmented nevus is an ideal therapeutic method. Meanwhile, it’s a worth of clinical use as an ideal method to repair wounds after excising lesion in plastic surgery. |
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