Expanded Island Scalp Flap Reconstruction After Excision of Giant Congenital Melanocytic Nevi in Children

Aesthetic reconstruction after excision of giant congenital melanocytic nevi (GCMN) involving the facial and temporal regions remains challenging in pediatric patients. This study evaluates the outcomes of a reconstructive strategy combining expanded island scalp flaps based on the superficial temporal artery with postoperative semiconductor laser hair removal.

A retrospective review was conducted of 5 pediatric patients with unilateral facial congenital melanocytic nevi treated at our institution between 2017 and 2025. Reconstruction was performed in 2 stages. Initially, multiple tissue expanders were implanted adjacent to the lesion. After achieving an expansion volume exceeding 150% of expander capacity, second-stage reconstruction was completed using expanded island scalp flaps. Flap survival and postoperative complications were recorded. Semiconductor laser hair removal was initiated on postoperative day 7 using an 810-nm laser at an energy density of 10 to 20 J/cm². Aesthetic outcomes were assessed at 6 months, 1 year, 2 years, and 3 years postoperatively using the global aesthetic improvement scale (GAIS) and the Vancouver scar scale (VSS).

Five single-pedicle expanded island scalp flaps were successfully transferred, with complete flap survival and no major complications. Laser hair removal was effective in all patients. Vancouver scar scale scores ranged from 3 to 7, and all patients achieved a GAIS score of 4.

Expanded island scalp flap reconstruction combined with postoperative laser hair removal provides a reliable and effective option for aesthetic reconstruction following unilateral facial GCMN excision in children.