ABSTRACT
INTRODUCTION AND IMPORTANCE: Giant congenital melanocytic nevus increases the risk of melanoma and seriously affects the aesthetics and psychology of patients, influencing the personality development of children. CASE PRESENTATION: A 7-year-old female child presented with a giant congenital melanocytic nevus on the back, which extended from the right anterior abdominal wall to the left flank Taking advantage of the elasticity of children's skin, we performed serial excision and obtained favourable results. The procedure included seven surgeries, and the average interval between the surgeries was 7 months. The nevus was partially resected from the periphery to the centre, and the direction of excision of the nevus depended on the mobilisation of the surrounding normal skin, including from the shoulder downward, lateral to medial, and from the bottom upward. After the seventh surgery at 11 years of age, the nevus was completely removed, and there were no complications. CLINICAL DISCUSSION: Serial excision is a simple and less invasive surgical technique that can achieve both complete excision and a satisfactory aesthetic result for giant congenital melanocytic nevus. The giant nevus of the back can be removed completely after several procedures due to the very good elasticity of the skin and the great ability of natural expansion of healthy skin under a considerable stretching force in children. CONCLUSION: Serial excision is an effective method for treating dorsal giant congenital melanocytic nevus in children because of excellent natural skin elasticity.
ABSTRACT
Background: Currently, large defects of the dorsum and finger of the hand pose a great challenge to plastic surgeons. The most difficult problem is finding a suitable material that has a large area and a thin, reliable blood supply and can be tailored into many small flaps to cover the fingers. Case series: We present the cases of two patients admitted to our hospital with scars on the dorsal side of the hand after gas burns. The defects after scar release were reconstructed by microdissected tailoring of the free anterolateral thigh flap. Complete survival was achieved for all flaps, including the small flaps tailored for finger defects. The function and aesthetics of the hands significantly improved. The patients were satisfied after the pain, itching, and burning symptoms of the scar were relieved. Conclusion: Microdissected tailoring of the free anterolateral thigh flap is an ideal method for addressing hand defects. The microdissected tailoring technique allows the surgeon to construct a thin flap with a reliable blood supply from the perforator.
ABSTRACT
INTRODUCTION AND IMPORTANCE: Xanthomas are a rare condition with the appearance of exogenous masses on the body, and it is common in patients with familial hypercholesterolemia (FH). For multiple large xanthomas, surgical excision is optimal to improve the patient's quality of life. CASE PRESENTATION: A 34-year-old male patient presented with multiple large tuberous xanthomas related to FH. There were 15 masses in different body parts, including the dorsum of the hands, elbows, buttocks, feet, and Achille's tendon. The largest masses in the buttocks measured 8 × 8 × 5 cm. Surgical removal of 13 masses was carried out in combination with medical treatment. The skin incision was oval around the circumference of masses with the longitudinal axis parallel to the Langer's line. Skin defects were closed directly or dissected on both sides of the incision to reduce tension. Wound healing was normal. After 1.5 months, there was no recurrence of xanthomas. CLINICAL DISCUSSION: Surgical treatment easily removes the entire tuberous xanthomas. The healing process is completely normal. Resection should be indicated for tuberous xanthomas that cause negative functional and aesthetic effects. Besides, lipid-lowering therapy is necessary to prevent tuberous xanthomas recurrence as well as premature coronary artery diseases. CONCLUSION: Surgical treatment of patients with multiple large tuberous xanthomas related to familial hypercholesterolemia was performed safely and successfully. After 1.5 months of follow-up, the wound healed well and no recurrence of xanthomas was detected. We recommend that a further study is needed to investigate post-treatment recurrence for multiple large xanthomas.
