Tumescent local anaesthesia for the surgical therapy of congenital nevi in the first year of life

Abstract

Background:The indication for surgical treatment of congenital nevi must be made after individual consideration of the expected benefit and risk and requires careful information of the parents as well as interdisciplinary psychological support. In addition to suspected malignancy, a relevant indication is the risk of stigmatization depending on the size and localization of the nevus. Objective was to show which size reduction of the congenital nevus can be achieved by surgical therapy under tumescent local anaesthesia (TLA) in infancy and how often complications of anaesthesia or surgery occur. Methods: All infants up to 12 months of age who underwent surgery for a congenital nevus under TLA at the University Dermatological Clinic Tuebingen between January 2015 and December 2021 were included; surgeries were performed using serial excisions (powerstretching technique), whereby the incisions were made inside the nevus and mobilization was strictly limited to the skin side without nevus. Results: Overall, a cumulative total area of 38.65 cm 2 could be removed on average within the first year of life (trunk: 67 cm 2 , head: 21.2 cm 2 , legs: 21.6 cm 2 , arms: 13.2 cm 2 ). A cumulative maximum area reduction of 406.9 cm 2 could be achieved. We evaluated 363 surgical sites (123 children) on all body regions. The median age of the children at the first surgery was 3.5 months (0.46-10.7 months). Complications occurred in 2.3% (seven procedures). All these complications were reversible in the course of the operation and did not lead to a prolonged hospital stay. No anaesthesiarelated complications occurred. Conclusion:We were able to show that a reduction of large areas of congenital nevi is possible in the first year of life with the combination of serial excisions using powerstretching technique, TLA, and intracutaneous butterfly sutures.

Surgical Therapy of Congenital Nevi in the First Year of Life—Psychological Impact on Parents

“…10 The power stretching technique allows excisions of large tissue parts without the need for suture removal, which can be bothersome or even painful for children. 24 In addition, there is no need for painful stretching of the skin before the actual procedure as with expander techniques, nor is it necessary to harvest skin for grafting at a second site.…”