Multiple stage tissue expansion for reconstruction of scalp nevocellular nevus in pediatric age group.

Aim: To present a rare case of giant congenital nevocellular nevus in a 7-year-old girl's scalp and to highlight our management steps and outcomes. Case description: An otherwise healthy 7-year-old girl presented to plastic surgery clinic with a giant congenital nevus (GCN) that covered almost her entire scalp that was treated successfully with tissue expander three times over a period of 14 months. A total of 34 cm width of skin, which comprised 78% of the patient's scalp, was removed. The patient was reassessed five years later with a great cosmetic outcome represented by a remarkable hair growth and near normal scalp appearance. Conclusion: Giant scalp nevocellular nevi in pediatric age group can be treated completely with tissue expanders more than twice to achieve near normal outcomes.

Reconstruction of Congenital Sternal Clefts: Surgical Experience and Literature Review.

BACKGROUND: Sternal cleft is a rare anomaly with a reported incidence of 1:100,000 cases per live births. Surgical intervention represents a crucial factor altering the overall patient prognosis, since they are at high risk of impaired oxygenation, as well as multiple chest infections. Herein, we are reporting our experience of surgical management of such rare cases, alerting plastic surgeons to their possibly crucial role in the reconstructive team. METHODS: A retrospective chart review of 2 cases presenting with chest wall defects. All perioperative data were collected and presented. RESULTS: Two patients with sternal clefts of variable degrees were managed. The first was an 18-month-old boy with partial inferior sternal cleft, who was otherwise asymptomatic. The patient underwent reconstruction at the same age using autologous rib graft and pectoralis major flaps due to ectopia cordis that was putting the patient at higher risk for cardiac trauma. The second patient was a 3-month-old girl having a V-shaped partial superior cleft with lung herniation. Surgical reconstruction was applied due to difficulty in weaning the patient off of ventilator support. Initially, reconstruction was applied with SurgiMend dermal matrix, but this was complicated by chest retraction and high oxygen requirement. Definitive reconstruction was later applied with allogeneic bone graft and pectoralis major flaps. CONCLUSIONS: Meticulous patient assessment and screening for associated anomalies are crucial. Surgical intervention is warranted at an early age. The use of acellular dermal matrix products in the reconstruction is of interest, but should be approached with caution.