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Published in: European Journal of Plastic Surgery 6/2023

15-11-2023 | Original Paper

Application of a pre-expanded cross-legged tubed flap to reconstruct extensive GCMN of distal lower limb in children

Authors: Jifan Yang, Bing Han, Jincai Fan, Jipeng Song, Tiran Zhang, Qi Pan, Jia Tian

Published in: European Journal of Plastic Surgery | Issue 6/2023

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Abstract

Background

Reconstructing extensive giant congenital melanocytic nevus (GCMN) of children’s distal lower limbs remains a challenge for plastic surgeon. In this article, we introduced a pre-expanded cross-legged tubed flap for reconstruction of extensive GCMN in distal lower limbs of children.

Methods

Thirteen children were enrolled in our study. The whole surgical course was divided into four stages, including implantation of a tissue expander, formation of the tubed flap, cross-legged posture phase, and transfer of the flap. Postoperative follow-up and a questionnaire survey were conducted for determining multifaceted outcomes of the flaps.

Results

Eighteen pre-expanded cross-legged tubed flaps were harvested in the 13 children. Five of the 13 children received the treatment for two times. Mean size of these flaps was over 2% of total body surface area (TBSA) in our cases. The flaps were successfully transferred without serious complication. With the follow-up over 12 months, the flaps demonstrated satisfying outcomes functionally and esthetically. Nine of the 13 children’s legal guardians finished the questionnaire. Six children were found more positive in the social communication after the surgery.

Conclusions

Pre-expanded cross-legged tubed flap is an efficient, esthetically pleasing, and safe way for reconstruction of extensive GCMN in children’s distal lower limbs, which is meaningful for children’s social well-being.

Level of evidence

Level VI, Therapeutic
Literature
1.
go back to reference Slutsky JB, Barr JM, Femia AN, Marghoob AA (2010) Large congenital melanocytic nevi: associated risks and management considerations. Semin Cutan Med Surg 29(2):79–84CrossRefPubMed Slutsky JB, Barr JM, Femia AN, Marghoob AA (2010) Large congenital melanocytic nevi: associated risks and management considerations. Semin Cutan Med Surg 29(2):79–84CrossRefPubMed
2.
go back to reference Martins da Silva VP, Marghoob A, Pigem R, Carrera C, Aguilera P, Puig-Butillé JA, Puig S, Malvehy J (2017) Patterns of distribution of giant congenital melanocytic nevi (GCMN): the 6B rule. J Am Acad Dermatol 76(4):689–694 Erratum in: J Am Acad Dermatol. 2021 Aug;85(2):532CrossRefPubMed Martins da Silva VP, Marghoob A, Pigem R, Carrera C, Aguilera P, Puig-Butillé JA, Puig S, Malvehy J (2017) Patterns of distribution of giant congenital melanocytic nevi (GCMN): the 6B rule. J Am Acad Dermatol 76(4):689–694 Erratum in: J Am Acad Dermatol. 2021 Aug;85(2):532CrossRefPubMed
3.
go back to reference Risk of malignant transformation arising from giant congenital melanocytic nevi: a 20-year single-center study Risk of malignant transformation arising from giant congenital melanocytic nevi: a 20-year single-center study
4.
go back to reference Price HN, Schaffer JV (2010) Congenital melanocytic nevi-when to worry and how to treat: Facts and controversies. Clin Dermatol. 28(3):293–302CrossRefPubMed Price HN, Schaffer JV (2010) Congenital melanocytic nevi-when to worry and how to treat: Facts and controversies. Clin Dermatol. 28(3):293–302CrossRefPubMed
5.
go back to reference Su JJ, Chang DK, Mailey B, Gosman A (2015) Treatment of a giant congenital melanocytic nevus in the adult: review of the current management of giant congenital melanocytic nevus. Ann Plast Surg. 74(Suppl 1):S57–S61CrossRefPubMed Su JJ, Chang DK, Mailey B, Gosman A (2015) Treatment of a giant congenital melanocytic nevus in the adult: review of the current management of giant congenital melanocytic nevus. Ann Plast Surg. 74(Suppl 1):S57–S61CrossRefPubMed
6.
go back to reference Li X, Fan J, Ma J, Tian J (2021) Reconstruction of circumferential upper extremity defect using a bipedicle expanded flank flap. Ann Plast Surg 86(3):279–286CrossRefPubMed Li X, Fan J, Ma J, Tian J (2021) Reconstruction of circumferential upper extremity defect using a bipedicle expanded flank flap. Ann Plast Surg 86(3):279–286CrossRefPubMed
7.
go back to reference Han JS, Won CH, Chang SE, Lee MW, Choi JH, Moon KC (2014) Giant congenital melanocytic nevus with proliferative nodules mimicking a congenital malignant melanoma. Ann Dermatol 26(4):554–556CrossRefPubMedPubMedCentral Han JS, Won CH, Chang SE, Lee MW, Choi JH, Moon KC (2014) Giant congenital melanocytic nevus with proliferative nodules mimicking a congenital malignant melanoma. Ann Dermatol 26(4):554–556CrossRefPubMedPubMedCentral
8.
go back to reference Drut R, Drut RM, Cohen M (1999) Adnexal-centered giant congenital melanocyte nevus with extensive ganglioneuromatous component and trisomy 7. Pediatr Dev Pathol 2(5):473–477CrossRefPubMed Drut R, Drut RM, Cohen M (1999) Adnexal-centered giant congenital melanocyte nevus with extensive ganglioneuromatous component and trisomy 7. Pediatr Dev Pathol 2(5):473–477CrossRefPubMed
9.
go back to reference Caradona SA, Skidmore R, Gupta A, Bush CH, Ford MJ (2000) Giant congenital melanocytic nevus with underlying hypoplasia of the subcutaneous fat. Pediatr Dermatol 17(5):387–390CrossRefPubMed Caradona SA, Skidmore R, Gupta A, Bush CH, Ford MJ (2000) Giant congenital melanocytic nevus with underlying hypoplasia of the subcutaneous fat. Pediatr Dermatol 17(5):387–390CrossRefPubMed
10.
11.
go back to reference Boyers LN, Karimkhani C, Stevens E, High WA (2015) Innumerable nevi with giant congenital melanocytic nevus clinically mimicking neurofibromatosis: a diagnostic challenge. JAAD Case Rep 1(5):241–243CrossRefPubMedPubMedCentral Boyers LN, Karimkhani C, Stevens E, High WA (2015) Innumerable nevi with giant congenital melanocytic nevus clinically mimicking neurofibromatosis: a diagnostic challenge. JAAD Case Rep 1(5):241–243CrossRefPubMedPubMedCentral
12.
go back to reference Melnikov DV, Starceva OI, Ivanov SI, Garmi R, Sinelnikov MY (2020) a unique case of lower limb soft tissue reconstruction with a prefabricated bipedicled deep inferior epigastric artery flap. Plast Reconstr Surg Glob Open. 8(7):e2976CrossRefPubMedPubMedCentral Melnikov DV, Starceva OI, Ivanov SI, Garmi R, Sinelnikov MY (2020) a unique case of lower limb soft tissue reconstruction with a prefabricated bipedicled deep inferior epigastric artery flap. Plast Reconstr Surg Glob Open. 8(7):e2976CrossRefPubMedPubMedCentral
13.
go back to reference Grabs D, Faghahati S, Lampron A, Sobczak S, Maranzano J, Nayouf A (2021) The vascular exploration of the proximal femoral artery perforator region, an ideal donor site to choose cutaneous flaps of thin, supple, and glabrous skin: a cadaveric study. J Plast Reconstr Aesthet Surg 74(9):1999–2004CrossRefPubMed Grabs D, Faghahati S, Lampron A, Sobczak S, Maranzano J, Nayouf A (2021) The vascular exploration of the proximal femoral artery perforator region, an ideal donor site to choose cutaneous flaps of thin, supple, and glabrous skin: a cadaveric study. J Plast Reconstr Aesthet Surg 74(9):1999–2004CrossRefPubMed
14.
go back to reference El-Shennawy HATM, Elzawawy EM, Atta-Allah ES, Omar SMMH (2022) Perforators of the anteromedial thigh skin and possible design of the anteromedial thigh flap: a cadaveric study. Ann Plast Surg 89(3):312–325CrossRefPubMed El-Shennawy HATM, Elzawawy EM, Atta-Allah ES, Omar SMMH (2022) Perforators of the anteromedial thigh skin and possible design of the anteromedial thigh flap: a cadaveric study. Ann Plast Surg 89(3):312–325CrossRefPubMed
15.
go back to reference Harris TGW, Khandge P, Wu WJ, Leto Barone AA, Manyevitch R, Sholklapper T, Bivalacqua TJ, Burnett AL, Redett RJ 3rd, Gearhart JP (2022) Sexual health outcomes after penile reconstruction in the exstrophy-epispadias complex. J Pediatr Urol 18(6):747–755CrossRefPubMed Harris TGW, Khandge P, Wu WJ, Leto Barone AA, Manyevitch R, Sholklapper T, Bivalacqua TJ, Burnett AL, Redett RJ 3rd, Gearhart JP (2022) Sexual health outcomes after penile reconstruction in the exstrophy-epispadias complex. J Pediatr Urol 18(6):747–755CrossRefPubMed
16.
go back to reference Hyuk KS, Sungmi J, Ho JY et al (2020) Verifying the versatility and reliability of free lateral arm flap for head and neck reconstruction. J Craniofac Surg 31:e688–e693CrossRef Hyuk KS, Sungmi J, Ho JY et al (2020) Verifying the versatility and reliability of free lateral arm flap for head and neck reconstruction. J Craniofac Surg 31:e688–e693CrossRef
17.
go back to reference Monagle P, Newall F (2018) Management of thrombosis in children and neonates: practical use of anticoagulants in children. Hematology Am Soc Hematol Educ Program. 2018(1):399–404CrossRefPubMedPubMedCentral Monagle P, Newall F (2018) Management of thrombosis in children and neonates: practical use of anticoagulants in children. Hematology Am Soc Hematol Educ Program. 2018(1):399–404CrossRefPubMedPubMedCentral
18.
go back to reference Raffini L, Huang YS, Witmer C, Feudtner C (2009) Dramatic increase in venous thromboembolism in children’s hospitals in the United States from 2001 to 2007. Pediatrics 124(4):1001–1008CrossRefPubMed Raffini L, Huang YS, Witmer C, Feudtner C (2009) Dramatic increase in venous thromboembolism in children’s hospitals in the United States from 2001 to 2007. Pediatrics 124(4):1001–1008CrossRefPubMed
19.
go back to reference Abdelmegeed AG, Abulezz TA, Abo-Saeda MA, Allam KA (2021) Perforator-based pedicled cross-leg flaps in pediatric patients: a new idea to increase flap reach. Ann Plast Surg 86(5):568–572CrossRefPubMed Abdelmegeed AG, Abulezz TA, Abo-Saeda MA, Allam KA (2021) Perforator-based pedicled cross-leg flaps in pediatric patients: a new idea to increase flap reach. Ann Plast Surg 86(5):568–572CrossRefPubMed
Metadata
Title
Application of a pre-expanded cross-legged tubed flap to reconstruct extensive GCMN of distal lower limb in children
Authors
Jifan Yang
Bing Han
Jincai Fan
Jipeng Song
Tiran Zhang
Qi Pan
Jia Tian
Publication date
15-11-2023
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Plastic Surgery / Issue 6/2023
Print ISSN: 0930-343X
Electronic ISSN: 1435-0130
DOI
https://doi.org/10.1007/s00238-023-02139-0

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