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


ePlasty. 2018;18(e30) 

In This Article


Case Presentation

An 8-year-old boy presented with an extensive, large, black, hairy skin patch over the left periorbital area, forehead, cheek, and nose since birth. There was no family history of similar lesions or skin cancer. The patient had no neurological symptoms and was not taking any medications. Examination revealed a large pigmented patch, measuring approximately 13 cm in its greatest dimension on the left periorbital area and extended to cover nearly half of the face (Figure 1). There was no increase in the size or change in color of the lesion since birth, and there was no pain, itching, or discharge. No other satellite lesions were present over the body, and there were no associated congenital anomalies. Parents' counseling indicated that the lesion was affecting his school and social activities.

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.

Treatment and Outcomes

We performed a single-stage complete excision of the lesion under general anesthesia after discussing the surgical risks and benefits, and the potential for malignancy, with the family of the patient. Functional reconstruction was performed first with a thin Dermal Regeneration Template (Matriderm 1 mm). Next, 12/1000-inch split-thickness skin graft harvested from the anterior scalp was secured on top of it using absorbable sutures. Separate sheets of skin graft were applied to different anatomic areas following the subunit principle of reconstruction where feasible.

In addition, full-thickness skin grafts harvested from the postauricular region were used to cover the upper and lower eyelids (Figure 2). The grafts were then secured with tie-over bolster dressing. The eyebrow was countered with a residual nevus for subsequent reconstructive session. Dressing was changed after 5 days, which showed minimal graft loss. Further follow-ups showed the healed donor site with no donor site morbidity or complications such as alopecia or hypertrophic scar.

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.

The postoperative result was satisfactory with excellent contour, color match, texture, and thickness to cover the giant defect created after excision. Further follow-up visits revealed that the patient and his family were fully satisfied with the cosmetic and functional results, with improvement in the child functional and social status (Figure 3).

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.