Functional Subunit Reconstruction of Giant Facial Congenital Melanocytic Nevi in Children With the Use of Matriderm and Skin Graft: Surgical Experience and Literature Review

Abstract

Introduction: Facial giant congenital melanocytic nevus represents a major cosmetic deformity for the child and parents and is a challenge for the plastic surgeons to achieve best cosmetic results. Herein, we present a case of single-stage surgical reconstruction using partial-thickness scalp skin graft aided with Matriderm dermal substitute for a facial giant congenital melanocytic nevus. Methods: An 8-year-old boy presented with a facial giant congenital melanocytic nevus without leptomeningeal involvement. A single-stage complete excision of the nevus was performed. A split-thickness skin graft, 12/1000-inch thick, was then harvested from the anterior scalp region for reconstruction. A 1-mm Matriderm dermal substitute was first applied, on which functional subunit skin graft was then secured to cover the defect. Eyelid reconstruction was reconstructed separately using full-thickness postauricular skin grafts. Results: Histopathology of the excised specimen confirmed the diagnosis of congenital melanocytic nevus, with no evidence of melanoma. The donor area healed with a favorable scar and no donor site morbidity or complications such as alopecia or hypertrophic scar. The postoperative result was satisfactory with minimal residual nevus around the eye, and the patient was fully satisfied with the cosmetic and functional results. Discussion and Conclusions: Resection of facial congenital melanocytic nevi, followed by single-stage reconstruction using Matriderm and skin graft from the scalp, is an excellent and fast reconstructive method with promising aesthetic outcomes and greater improvement in physiological outcome, especially in the pediatric population.

Keywords: dermal; face; graft; matrix; nevus.

Figure 1

The preoperative view of the giant congenital melanocytic nevus. Extensive black lesion on the left side of the face. Note the involvement of both upper and lower eyelids on the involved side.

Figure 2

The intraoperative view of the facial lesion after excision, followed by the application of Matriderm to the excised area. Nevus involving the eyelids was reconstructed using full-thickness skin graft.

Figure 3

Results after a follow-up period of 6 months: (a) 2 months; (b) 4 months; and (c) 6 months. Note the maturation of the healing process of split-thickness skin graft harvested from the scalp over Matriderm. Good color match is seen together with no associated alopecia at the scalp donor site.