title: Surgical management of large and giant congenital pigmented nevi of the lower extremity.
abstract: BACKGROUND
  The surgical treatment of large and giant congenital pigmented nevi of the lower extremity is a challenging endeavor with limited reconstructive options.
  
  
  METHODS
  Fifty large (>10 cm) and giant (>20 cm) congenital pigmented nevi of the lower extremity treated by the senior author (B.S.B.) over a 25-year period were reviewed. All of these nevi were too large for serial excision or direct closure.
  
  
  RESULTS
  A reconstructive algorithm based on the extent and location (thigh, knee, popliteal fossa, leg, and foot) of the nevus is proposed. The approach to each anatomical region is described in detail, along with nuances of tissue expansion in the extremities.
  
  
  CONCLUSIONS
  Treating large and giant congenital pigmented nevi of the lower extremity requires careful planning and often multiple stages. An evolution of the authors' approach to these lesions has led to improved outcomes. Contour and the limiting of scar contracture around the joints are of paramount importance.
authors.affiliation: Chicago, Ill. From the Division of Plastic Surgery, Children's Memorial Hospital, and Northwestern University Feinberg School of Medicine.
authors.forename: Zol B
authors.initials: ZB
authors.lastname: Kryger
authors.forename: Bruce S
authors.initials: BS
authors.lastname: Bauer
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000517:prevention & control / Q000601:surgery; D003286:Contracture / Q000517:prevention & control / Q000601:surgery; D004954:Esthetics; D005260:Female; D006801:Humans; D007223:Infant; D007866:Leg / Q000601:surgery*; D008297:Male; D009508:Nevus, Pigmented / Q000151:congenital* / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000151:congenital* / Q000601:surgery*; D016038:Skin Transplantation; D013524:Surgical Flaps; D015626:Tissue Expansion / Q000379:methods; D014945:Wound Healing