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Published on: January 3, 2020
[Radical excision of giant abdominal nevi in infants. Apropos of 3 cases]
Insights
Early surgical removal of giant congenital nevi in infants, especially on the abdominal wall, offers ideal outcomes with minimal scarring. This approach leverages infant skin elasticity for effective excision and closure, preventing malignancy and psychological distress.
Area of Science:
- Pediatric Surgery
- Dermatology
- Plastic Surgery
Background:
- Giant congenital nevi pose risks of malignancy and psychological distress.
- Infants possess excess skin ideal for wide excisions with immediate closure.
- Early intervention is crucial for optimal cosmetic and oncologic outcomes.
Observation:
- Presents three cases of abdominal wall giant nevus excision in infants (9, 3, and 6 months).
- Utilized wide undermining for immediate closure, preserving umbilicus in lower abdominal cases.
- Employed epinephrine infiltration and meticulous hemostasis to minimize blood loss.
Findings:
- All cases demonstrated uneventful healing with smooth, fine scars after 1-2 years.
- No contour changes were observed post-excision.
- Pediatric anesthesiology advancements make early, extensive surgery safe in infants.
Implications:
- The abdominal wall is a preferred site for early wide excisions of giant nevi.
- Early surgical management can significantly improve patient outcomes and quality of life.
- This technique minimizes the risk of malignant transformation and psychological impact in children.
Abstract:
Total removal of giant naevi with a minimal residual scar is of course ideal for prevention of malignancy and obvious psychological reasons. One can take advantage of the excess of skin existing in infants to be able to perform such wide excisions with immediate closure. Three cases of abdominal wall excisions in infants are presented, one of the upper abdomen at 9 months, two of the lower abdomen, at 3 months and 6 months. In all cases, a wide undermining was performed to allow the immediate closure. For the two lower abdominal excisions, preservation and transposition of the umbilicus were performed, like on an aesthetic abdominoplasty in adults. The blood loss was minimized by infiltration with epinephrine and meticulous hemostasis. Healing was uneventful. The scars, with a one to two years follow-up, are smooth and fine, and there are no change of contour. Progress in pediatric anesthesiology has resulted in the fact that a large excision and repair in infants presents no more potential dangers than operation performed later. Feasibility of such early wide excisions has been explored in other areas of the body; however, the abdominal wall is the area of choice.
