Management of giant congenital nevi with artificial skin substitutes in children

Giant congenital nevi are one of several skin conditions in the pediatric patient population whose treatment leaves the patient with large skin defects. The giant congenital nevus is a rare pigmented skin lesion that covers large skin areas or affects any major or difficult-to-treat region of the body, such as the face. Congenital nevi should be excised fully because of the increased risk for malignant transformation to melanoma, as well as cosmetic considerations. However, after excision patients are left with large wounds that are difficult to close. Traditionally these defects have been repaired with split-thickness skin grafts, full-thickness skin grafts, the use of tissue expanders, and a variety of flaps. However, each of these methods has its disadvantages and thus cannot be used in all cases. Recently, new methods have been developed for the closure of large skin defects in pediatric patients with the use of artificial skin substitutes. Advantages include coverage of large wounds, decrease or elimination of donor site pain and morbidity, and decreased scarring and wound contractures. The authors present these experiences through two case reports.