| Objective Observe the therapeutic effects of the operations on melanocytic nevus patients and discuss their advantages and disadvantages through the treatment of243patients with different melanocytic nevus sizes by different mode of operation.Methods The243cases of melanocytic nevus patients, who were treated in our department from January,2003to January,2013, were chosen as the clinical objects. According to their melanocytic nevi sizes, they were divided into3groups, including134cases of a small area (<20cm2),61cases of a medium area(20cm2-60cm2), and48cases of a large area(>60cm2). About four various types of operation such as direct fractional resection, resection of the lesion plus free skin graft, and embedding dilator predilation skin flap transfer operation,were adopted to treat these patients.The therapeutic effects of these operations on each patient could be observed and evaluated. All the cases were randomly selected according to the sizes, and the postoperative effects were assessed by the same doctor in the department.Results The evaluation of curative and cosmetic effects were carried out3months after the operation, under the natural light,50cm away from patients with visual inspection. There are standards of four levels:, there is no scar forming and change of chromatosis, and the lesions were completely removed;Level Ⅱ, the scar is not easy to see clearly.and there is no change of chromatosis;Ⅲ, visible scars are above or below the surface of skin to a slight degree, along with unapparent chromatosis change; Level IV, scars can be seen clearly above or below the surface of skin or lesions relapse, with evident changes of chromatosis.①Direct excision operation method of treatment were used in93cases, in which the lesions were totally excised and there was no recurrence after operation.. According to the sizes of melanocytic nevus,85patients were of small size group (63.43%of the total) and8patients were of medium size group (13.11%of the total), all of them treated by this method. The evaluation for the effects of operation treatment is as follows:37patients, were of Level Ⅰ (45.18%);26patients were of Ⅱ Level Ⅱ (31.18%);17patients were of Level Ⅲ (13.97%);13patients were of Level IV (9.67%). ②Fractional resection operation method of treatment were used in53cases, in which the lesions were totally excised and there was no recurrence after operation. According to the sizes of melanocytic nevus,42patients were of small size group (31.34%of the total) and11patients were of medium size group (18.03%of the total), all of them treated by this method. The evaluation for the effects of operation treatment is as follows:23patients were of Level Ⅰ(43.39%);20patients patients were of Level Ⅱ (39.65%);6patients were of Level Ⅲ (11.33%);4patients were of Level IV (5.66%).③Lesion resection and free skin graft operation method of treatment were used in48cases, in which the lesions were totally removed and there was no recurrence after operation with the selection of full thickness skin graft transplantation or autologous. According to the different sizes of melanocytic nevus and locations of the lesions,7patients were of small size group (5.22%in total),17were of medium size group (27.87%in total) and24were of large size group (50%of the total),all of them treated by this method. The evaluation for the effects of operation treatment is as follows:3patients were of Level Ⅰ (6.25%);9patients were of Level Ⅱ (18.76%);23patients were of Level Ⅲ (47.91%);13patients were of Level IV (27.08%).④Skin soft tissue dilation+lesion resection and flap operation method of treatment were used in49cases, According to the different sizes of melanocytic nevus and locations of the lesions,25patients were of small size group (40.98% in total), and24were of large size group (50% of the total),all of them treated by this method. The evaluation for the effects of operation treatment is as follows:10patients were of Level I (20.41%);22patients were of Level Ⅱ (44.89%);13patients were of Level Ⅲ (26.53%);4patients were of Level IV (8.17%).Conclusion①direct suture removal takes short time of operation, causing patients less pain. With good curative effects, it does not affect the repair and appearance of tissue and causes less postoperative complications.Most patients are satisfied with it,so it is the preferred treatment for melanocytic nevus of small size.②Partial excision method operation is targeted, fit for patients with melanocytic nevus of medium size who have much fat and rich subcutaneous tissue under the skin, and less usable skin surrounding the lesions, especially for children with facial melanocytic nevus③Free skin graft is a traditional treatment for repair of wound surface,which is often used after resecting melanocytic nevus of medium size, large size or special function parts of body. But it takses a long time to do the operation.In addition, much trauma as well as serious postoperative reaction can arise.There may be infection, hematoma, pigmentation, scar contracture, circularity shaped scars, disappearance of senses. This method has great impacts on the patient’s appearance and image, and few patients are satisfied with the results, Therefore, it is not a good way to treat melanocytic nevus of large size, and that on head and face.However,it can be applied to the repair for wounds located on the trunk, limbs or other special parts.④Skin dilator can be applied to the repair of the wounds caused by resecting melanocytic nevus of medium or large size on head and face. Compared with free skin graft operation, it has obvious advantages, which can provide skin similar to that around the wound in texture, color, thickness and feel. The repaired parts take on good condition and true to nature conformation, which means treatment effects is obvious, so the results are well recognized by most patients. However, patients should get frequent operations and the cost is rather high. The method is a relatively ideal one in cosmetic wound repair after orthopedic surgery,which is worth well introducing to clinical practice. |
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