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

BACKGROUND: 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. METHODS: 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). RESULTS: 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. CONCLUSIONS: 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.