Functional Subunit Reconstruction of Giant Facial Congenital Melanocytic Nevi in Children With the Use of Matriderm and Skin Graft

Surgical Experience and Literature Review

Nehal Mahabbat, MBBS; Nawaf Alohaideb, MBBS; Faris Aldaghri, MBBS; Feras Alshomer, MBBS, MSc; Mohamed Amir Murad, MBBS, FRCSC

Disclosures

ePlasty. 2018;18(e30) 

In This Article

Discussion

The management of GCMN remains controversial, with no specific guidelines. Treatment options vary on the basis of type, size, and location. Recent studies demonstrated that early excision of these giant lesions reduces the risk of malignant melanoma and the associated psychological distress in the child and parents.[13] Several therapeutic procedures have been considered. Nonsurgical options include dermabrasion, laser ablation, curettage, and chemical peel. Surgical options include staged excision with primary closure, skin graft, flap, skin substitute, or tissue expansion reconstruction;[14] however; surgical excision remains the standard of care. Since it is impossible to eliminate the risk of malignant transformation, GCMN removal is a reconstructive and aesthetic procedure, rather than prophylactic surgery.[15–17] Tissue expansion is the most commonly used modality for resurfacing the defect area after excision, with minimal donor site morbidity.[18] However, infection, hematoma, expander exposure, and implant failure are the most common complications of tissue expansion,[19] and their incidence is often reported to be higher in children.[20,21] Skin grafting is recommended for lesions involving aesthetic areas such as the face, ear, neck, hand, and foot. Usually, a supraclavicular graft is the first choice for facial reconstruction; however, to address the issue of color match, which is a challenge with skin grafts, we used the scalp skin as a donor site.

Dermal Regeneration Template (Matriderm) is a single-use 3-dimensional matrix composed of native, structurally intact collagen fibrils and elastin for supporting dermal regeneration. The collagen is obtained from bovine dermis and contains the dermal collagen types I, III, and V. The elastin is obtained from bovine nuchal ligament by hydrolysis. It serves as a scaffold in the skin reconstitution and modulates scar tissue formation.[22]

The use of acellular dermal matrix in the treatment of facial cutaneous defects has been vastly investigated in multiple fields, especially in burn defects, with great functional results.[23] Integra was shown to be of promising aesthetic results when it was used for various facial giant hairy nevus defect reconstruction. However, staged reconstruction at certain times might delay the finalized outcome.[24] We used Matriderm as a Dermal Regeneration Template in the defect reconstruction, avoiding the need for multiple stages or the complications associated with other options such as tissue expanders or the complexity of different reconstructive processes as microsurgical free tissue transfer with promising functional and aesthetic outcomes.

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