Giant congenital melanocytic nevus of the upper extremity: Coverage with a pre-expanded pedicled thoracodorsal artery perforator flap and re-expanded transferred flap

다국어 초록 (Multilingual Abstract)

Giant congenital melanocytic nevi are rare, and it is recommended to excise due to the possibility of malignancy. Although tissue expansion for nevus removal involves multiple stages, the advantages of tissue expansion are known well. We report a case of a giant congenital melanocytic nevus of the upper extremity that extended from the elbow to the shoulder. This case was challenging due to the circumferential nature of the lesion, the lack of healthy skin, the need to ensure minimal scarring, and the desire to impact the patient’s daily life as little as possible. The use of a pre-expanded thoracodorsal artery perforator (TDAP) flap and re-expansion of the transferred flap were considered most appropriate. A pre-expanded pedicled TDAP flap can be transferred to any anatomical region with its versatility. The re-expansion of the transferred flap ensures the health of the skin and minimizes donor site scarring. Here, we achieved the optimal outcome through the combined use of a pre-expanded pedicled TDAP flap and sequential re-expansion of the transferred flap in the treatment of a giant nevus of the upper extremity.

참고문헌 (Reference)

1 Ortiz CL, "Versatility of the pedicled thoracodorsal artery perforator(TDAP)flap in soft tissue reconstruction" 58 : 315-320, 2007

2 Wagh MS, "Tissue expansion: concepts, techniques and unfavourable results" 46 : 333-348, 2013

3 Zhi Yang Ng, "Soft Tissue Reconstruction of Complete Circumferential Defects of the Upper Extremity" 대한성형외과학회 44 (44): 117-123, 2017

4 Er E, "Reconstruction of axillary contractures with thoracodorsal perforator island flap" 31 : 726-730, 2005

5 Hocaoglu E, "Preexpanded perforator flaps of the dorsolateral trunk in pediatric patients" 131 : 1077-1086, 2013

6 Corcoran J, "Management of large melanocytic nevi in the extremities" 16 : 877-885, 2005

7 Balakrishnan C, "Lymphedema of the upper extremity following circumferential burns" 12 : 79-80, 2004

8 Inbal A, "Latissimus dorsi flap with vascularized lymph node transfer for lymphedema treatment: technique, outcomes, indications and review of literature" 115 : 72-77, 2017

9 이경태, "Improvement of Upper Extremity Lymphedema after Delayed Breast Reconstruction with an Extended Latissimus Dorsi Myocutaneous Flap" 대한성형외과학회 39 (39): 154-157, 2012

10 Arneja JS, "Giant congenital melanocytic nevi" 124 (124): 1e-13e, 2009

11 Oksuz S, "Elbow reconstruction with a pedicled thoracodorsal artery perforator flap after excision of an upper-extremity giant hairy nevus" 66 : 566-569, 2013

12 Crosby MA, "Effect of intraoperative saline fill volume on perioperative outcomes in tissue expander breast reconstruction" 127 : 1065-1072, 2011

13 Kopf AW, "Congenital nevocytic nevi and malignant melanomas" 1 : 123-130, 1979

14 Lanier VC Jr, "Congenital giant nevi: clinical and pathological considerations" 58 : 48-54, 1976

15 Garza R 3rd, "A comprehensive overview on the surgical management of secondary lymphedema of the upper and lower extremities related to prior oncologic therapies" 17 : 468-, 2017