Extraordinary Large Giant Congenital Melanocytic Nevus Treated with Integra Dermal Regeneration Template
Kim A. Tønseth, MD, PhD,*†‡Charles Filip, MD, PhD,*†Robert Hermann, MD,*Harald Vindenes, MD,* and Hans Erik Høgevold, MD, PhD*†
The patient was born abroad after a normal pregnancy. Immediately after delivery, a very large voluminous GCMN of the back covering about 16% of the total body surface area and additional multiple smaller nevi on the body were demonstrated. The patient and his family immigrated to Norway, and he was referred to our hospital when he was 1.5 years old (Fig.1). His main complaints were severe itching and difficulty in normal everyday activities and sleeping due to the large tumor.
Based on the patient’s complaints, we decided to perform a two-stage operation with (1) excision of the large tumor (Fig.2) and coverage with Integra (Fig.3) and (2) 3 weeks later split-thickness skin transplantation of the 100% vascularized Integra. The split-thickness skin transplantation was harvested with 0.008-inch thickness, meshed 1:1.5, and fixed with vacuum-assisted closure technique at 80 mm Hg (Smith & Nephew, Hull, United Kingdom). Due to multiple smaller nevi on the rest of the body, the split-thickness skin transplant was harvested including these lesions. After additional 5 days, the bandage was removed and 90% of the split-thickness skin transplant had healed. A secondary split-thickness skin transplantation procedure was performed, and 2 months after the primary operation the defect was completely healed (Fig.4).
From the *Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway; †Institute for Surgical Research, Oslo University Hospital, Oslo, Norway; and ‡Faculty of Medicine, University of Oslo, Oslo, Norway.Corresponding author.Kim A. Tønseth, MD, PhD, Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway, E-mail: on.fh-suo@htesnotk
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