Background:
Port wine stain (PWS) is a congenital cutaneous capillary malformation that typically presents on the face and neck, with an incidence of 0.3%–0.5% in newborns. It often occurs in a dermatomal distribution of the trigeminal nerve. PWS does not involute with time, but if left untreated, the lesion can generate hypertrophy and nodules. PWS has a favorable prognosis with early diagnosis and treatment and pulsed-dye laser (PDL) is the gold standard treatment. Patients that fail to receive treatment early in life may subsequent develop lesions more likely to progress. Herein, we present our experience in treating port wine stain with hypertrophic and nodular change.
Material and Methods:
A retrospective study was conducted between Jan 2012 to Aug 2022. All patients diagnosed as port wine stains with nodular change who underwent operation were all enrolled. The data of patient’s age, lesion site, operative procedure and complication were all collected. The operative procedure includes two stage reconstruction with tissue expander(TE) placement followed by rotation flap, split-thickness skin graft (STSG) and full-thickness skin graft (FTSG).
Results:
A total of 19 patients were included in this study, of whom 47.4% and 52.6% were men and women, respectively. Their mean age was 43.37 years, with the youngest patient aged 22 years and the oldest patient aged 68 years. Ten patients underwent two stage reconstruction with TE placement followed by rotation flap, five underwent STSG, one underwent series of STSG, one underwent FTSG, two underwent STSG combined with FTSG. There were two flap edge necrosis noted in the TE group and both received debridement and STSG for salvage. There was no complication noted in the skin graft group.
Conclusions:
PWS with hypertrophic and nodular change could cause aesthetic and functional concern and the patients were reported to experience high level of anxiety and depression. Excision of nodules followed by reconstructive procedure is the first choice for the late stage of PWS. We have reported that PWS with nodular change on cheek could benefit from TE placement and subsequent second stage rotational flap. FTSG could be the choice for the lesions over upper, lower eyelid area and dorsal nose. Also the satisfying results are noted after large area excision of frontal, temporal, and cheek followed by STSG apply.