Aesthetic Reconstruction of Congenital Cerebriform Intradermal Nevus by Sequential Tissue Expansion at an Early Age: Ten-year Follow-up

DOI: 10.7247/jiumf.19.3.9 Cerebriform intradermal nevus (CIN) is a congenital tumoral abnormality of the scalp. The incidence of development of malignant melanoma in CIN can rise up to 10%. Surgical excision of the lesion is the sole treatment modality for CIN. In this case, we present the 10year follow-up of a 45-day-old infant with congenital CIN covering 75% of his scalp who had scalp reconstruction by sequential tissue expansion. Sequential tissue expansion processes with rectangular-shaped expanders of 450, 400, and 250 ml in size, respectively, were applied over an eight-month period. The interval between the two procedures was two weeks. The tissue expansion technique is a useful option for hair-bearing scalp reconstruction. This technique can be used sequentially or gradually. In order to obtain homogenous follicle distribution, the rest of the scalp should be expanded as much as possible. Careful planning in large defects helps prevent complications. In this case, we applied a sequential tissue expansion procedure when the patient was 45 days old, and the expansion period was continued for eight months. This very early age is a unique case for tissue expansion applications when compared with examples in the literature. On the other hand, we want to underline the aesthetic result of this case rather than the reconstructive method. Reconstruction of huge scalp defects by re-expansion (sequential expansion) and leaving the expander beneath the expanded flap until the sequential procedure decrease flap contracture reduces the required number of operations, and produces better aesthetic outcomes.