chondroitin-sulfates and Nevus--Pigmented

The purpose of this paper is to highlight the risk of early malignant transformation in infants with giant congenital melanocytic nevi (GN) and demonstrate the potential for earlier intervention with aggressive surgery. We describe the case of a child born with a GN who developed a metastatic melanoma early in life, despite early commencement of resection of the nevus. This is contrasted against a second case of a child in which a more radical management was conducted. Despite early commencement of serial resection of the GN, the first child in this series died of metastatic melanoma prior to complete excision of the nevus. With the second child, radical excision combined with the use of Integra™ and negative pressure wound therapy allowed total removal of the GN within the first 6 months of life.

Topics: Cell Transformation, Neoplastic; Chondroitin Sulfates; Collagen; Fatal Outcome; Female; Humans; Infant; Melanoma; Negative-Pressure Wound Therapy; Nevus, Pigmented; Skin Neoplasms; Time-to-Treatment

Integra dermal regeneration template has been well established in treating deep extensive burns, but there are very few cases reported of treating large full-thickness skin defects such as giant nevi. Apart from psychological and cosmetic burdens, the giant congenital nevus carries increased risk of malignant alteration. We present the case of a 9-year-old girl with a giant congenital nevus on her left lower leg. A total excision was done and she was successfully treated with Integra (LifeSciences Corp, Plainsboro, NJ). Three weeks later, a thin split-skin graft was applied over the neodermal skin layer. The takeoff was 91%. Protected with the silver wound dressing, the rest of the wound healed. A donor site morbidity was minimal, and the final result was excellent both in aesthetic and functional aspects.

Topics: Biocompatible Materials; Child; Chondroitin Sulfates; Collagen; Female; Humans; Leg; Nevus, Pigmented; Plastic Surgery Procedures; Skin Neoplasms; Treatment Outcome; Wound Healing

Integra artificial skin (Integra) (Integra Life Sciences Corporation, Plainsboro, NJ) is increasingly used as a skin substitute in reconstructive surgery. However, reliable fixation to the wound bed, a factor of paramount importance for successful application, is often hard to achieve. The vacuum-assisted closure system (VAC; KCI, Switzerland), a well-established subatmospheric pressure device, might be of interest to overcome these problems because of its ability to conform to almost any surface. The goal of this study was to test whether negative pressure application yields reliable fixation of Integra in children undergoing reconstructive surgery.. Between 2001 and 2004, VAC was applied in 18 children (n = 18) aged 7 months to 16.5 years. All required reconstructive surgery with implantation of Integra covering 1% to 12% of the total body surface area. After Integra implantation, VAC was installed for 13 to 30 days.. The VAC fixation of Integra was successful in 17 patients (94.5%). The only failure (5.5%) occurred in a patient in whom negative pressure could not be maintained because of a lesion site susceptible to both dislodgement and infection (perianal region). Consequently, infection occurred, and Integra had to be removed.. These results demonstrate that VAC is a valid tool for reliable fixation of Integra in children undergoing even demanding reconstructive surgery.

Topics: Adolescent; Child; Child, Preschool; Chondroitin Sulfates; Cicatrix, Hypertrophic; Collagen; Female; Hamartoma; Humans; Infant; Male; Negative-Pressure Wound Therapy; Nevus, Pigmented; Plastic Surgery Procedures; Skin Neoplasms; Skin, Artificial

In our modern health system, the improvement of the medical care cannot come along with an increase of expenses. In this purpose, we tried to bring to light the medical and economic, direct and indirect, benefits which exist with the association of an artificial dermis, Integra, and negative pressure therapy as the vacuum assisted closure (VAC) for wound which would have been treated by Integra alone. While preserving the aesthetic and functional qualities obtained by the artificial dermis alone followed by a skin graft after 21 days of treatment, the association of the negative pressure allows to perform the skin graft after only 10 days of treatment. This gain of time is a financial economy for the medical centers which have to shorten the durations of stay to be profitable. The patient benefits of a shorter hospitalization and will manage to return to work earlier. The quality of the treatment is not only improved by the absentia of immobilization of the patient but also by the decrease of the complications and the infectious risks due to the use of artificial dermis. The results so obtained highlight that in spite of the initial expense caused by this association the advantages are such that the use of the artificial dermis alone will not have interest any more.

Topics: Abdomen; Adult; Chondroitin Sulfates; Cicatrix, Hypertrophic; Collagen; Elbow; Extremities; Female; Forearm; Humans; Male; Negative-Pressure Wound Therapy; Nevus, Pigmented; Plastic Surgery Procedures; Skin Neoplasms; Thoracic Wall; Treatment Outcome

We report the case of a 17-year-old boy who was precluded from entering basic military training because of the presence of a giant hairy melanocytic nevus that covered his back. He subsequently underwent total excision of the lesion followed by application of a dermal regeneration matrix, Integra, and split-thickness skin grafting. Ten months following the procedure, his wounds had healed and the reconstructed skin was considered durable enough to withstand the rigors of military training. He has since been allowed to reapply for recruit training. This case illustrates the utility of a dermal regeneration template in the military patient, where both strong biomechanical properties as well as skin coverage are required to help meet the demands of military training.

Topics: Adolescent; Chondroitin Sulfates; Collagen; Health Status; Humans; Male; Military Medicine; Nevus, Pigmented; Skin Transplantation; United Kingdom

Topics: Adaptation, Psychological; Attitude to Health; Child; Chondroitin Sulfates; Collagen; Female; Humans; Nevus, Pigmented; Parents; Perioperative Care; Professional-Family Relations; Skin Care; Skin Neoplasms; Social Support

Topics: Biocompatible Materials; Child; Chondroitin Sulfates; Collagen; Dermatologic Surgical Procedures; Female; Humans; Infant; Male; Nevus, Pigmented; Plastic Surgery Procedures; Regeneration; Skin Neoplasms; Skin Physiological Phenomena

Giant congenital melanocytic nevi represent a surgical challenge, particularly in cases in which the size of the nevus exceeds certain extend and malignant transformations have to be considered.. To discuss through case report considerable surgical options when extensive giant congenital melanocytic nevi with malignant transformation are encountered.. We present an unusual case of a giant congenital melanocytic nevi of the entire back of a 44-year-old patient. To achieve radical resection with direct appropriate wound closure and acceptable outcome, the integument of the entire back was excised and covered with Integra, followed by split-thickness skin grafting after stable integration of the matrix.. The approach resulted in a complete excision of the tumor and acceptable cosmetic and excellent biomechanical outcome.. The introduced practice demonstrates a useful alternative to established methods, particularly if tumor excision in large areas and subsequent wound closure might be achieved in one procedure.

Topics: Adult; Antineoplastic Agents; Axilla; Back; Biocompatible Materials; Cell Transformation, Neoplastic; Chondroitin Sulfates; Collagen; Female; Groin; Humans; Interferon-alpha; Lymph Node Excision; Melanoma; Neoplasm Staging; Nevus, Pigmented; Plastic Surgery Procedures; Skin Neoplasms; Skin Transplantation; Skin, Artificial

There are various artificial skin substitutes available commercially. The authors have used Integra, cultured epithelium, and Apligraf in their clinic. In the present report, they present their experiences based on two case reports. The first patient was a 12-year-old boy with widespread skin defects and left axillary contracture due to epidermolysis bullosa (EB). Apligraf was used to cover the skin defects on the trunk and face and to manage ectropion and axillary contracture. The second patient was a 6-year-old boy who suffered neurocutaneous melanosis. Partial excision of a pigmented lesion on the back created a large defect. Integra application followed by repair with cultured autologous skin was accomplished, and the results were satisfactory. Skin substitute products 1) are commercially immediately available; 2) are effective for management of contractures, chronic wounds, and chronic skin illnesses; 3) decrease or avoid the risk of donor area morbidity, which is more difficult to treat in children; 4) provide long-term coverage of the wound; and 5) can be used in conjunction with autologous tissue (e.g., Integra followed by cultured epithelium applications).

Topics: Biocompatible Materials; Child; Chondroitin Sulfates; Collagen; Contracture; Epidermolysis Bullosa; Humans; Male; Nevus, Pigmented; Skin Neoplasms; Skin Transplantation; Skin, Artificial; Transplantation, Autologous