ABSTRACT
Congenital large and giant nevi of the extremities still present a considerable challenge due to the limitations of expansion techniques in many of these areas, and the relatively poor esthetic outcome experienced with some grafting techniques. The current authors’ prior approach utilized both split-thickness and expanded full-thickness skin grafts for most lesions, but the longterm soft-tissue contour defect as well as pigment abnormalities in the grafted skin have led to the use of alternative approaches when possible. In upper extremity lesions, use of transposition flaps from the upper back and shoulder, have effectively eliminated contour defects to the proximal upper extremity (Figs 72.15-17). An expanded free TRAM flap has offered a possible avenue for larger lesions, and pedicle flaps from the flank (both expanded and non-expanded) have offered ways of improving long-term contour (e.g. complete
uniform single flap coverage following excision of a circumferential nevus from elbow to wrist with an expanded pedicle flap from the abdomen and flank. Figs 72.18-20). Similar approaches will be applied to increasingly larger lesions on the lower extremity as the current authors’ experience progresses.
