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

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.

Refinements in the pre-expanded distant flap for giant melanocytic nevi of the upper extremity in pediatric patients

“…In addition to distant flaps, various attempts have included the preexpanded thoracodorsal artery perforator flap, free flap methods such as the transverse rectus abdominis myocutaneous flap, and bipedicled flaps. 17,[28][29][30] No matter how much expansion is performed, considering the donor-site closure, the maximum flap size for pediatric patients is limited. It was intended to raise the flap to the largest possible area without an even free flap.…”