Gallico G G, O'Connor N E, Compton C C, Remensnyder J P, Kehinde O, Green H
Shriners Burns Institute, Boston, Mass.
Plast Reconstr Surg. 1989 Jul;84(1):1-9. doi: 10.1097/00006534-198907000-00001.
Eight pediatric patients with giant congenital nevi confluent over 21 to 51 percent body surface area were treated by excision and grafting. The nevus was excised to the muscle fascia, and the open wound was grafted with cultured epithelial autografts and split-thickness skin grafts. The patients have been followed from 17 to 56 months. Seventeen operations were performed in the eight patients, excising a mean of 6.9 percent body surface area at each procedure. The mean duration of anesthesia was 3.7 hours, and the mean operative blood loss was 12.3 percent estimated blood volume. The mean "take" for the cultured epithelial autografts was 68 percent, and for the split-thickness skin grafts, 84 percent. Epithelialization of open wound areas adjacent to the grafts was somewhat slower for the cultured epithelial autografts than for the split-thickness skin grafts, but it led to a healed wound in all patients except one. Ten of the 17 areas grafted with cultured epithelial autografts resulted in small open wounds that required regrafting. Wound contraction under the cultured epithelial autografts and under split-thickness skin grafts was similar and depended more on the anatomic site grafted than on the type of graft employed. in 16 of 17 operations, the cultured epithelium remained as a permanent, durable skin coverage. The use of cultured epithelial autografts allowed a larger area of excision than would have been possible with split-thickness skin grafts alone and, therefore, a more rapid removal of nevus. Cultured epithelial autograft are an important new technique in the care of patients with giant congenital nevi.
8例先天性巨痣累及体表面积21%至51%的儿科患者接受了切除及植皮治疗。将痣切除至肌肉筋膜层，开放伤口用培养的自体上皮移植物和中厚皮片进行移植。对这些患者进行了17至56个月的随访。8例患者共进行了17次手术，每次手术平均切除体表面积的6.9%。平均麻醉时间为3.7小时，平均术中失血量为估计血容量的12.3%。培养的自体上皮移植物的平均“成活率”为68%，中厚皮片的平均“成活率”为84%。与中厚皮片相比，培养的自体上皮移植物邻近开放伤口区域的上皮化速度稍慢，但除1例患者外，所有患者的伤口均愈合。17个用培养的自体上皮移植物移植的区域中有10个导致小的开放伤口，需要再次移植。培养的自体上皮移植物下和中厚皮片下的伤口收缩情况相似，更多地取决于移植的解剖部位而非所用移植物的类型。在17次手术中的16次，培养的上皮作为永久性、耐用的皮肤覆盖物保留下来。使用培养的自体上皮移植物比单独使用中厚皮片能够切除更大的面积，因此能够更快速地切除痣。培养的自体上皮移植物是治疗先天性巨痣患者的一项重要新技术。
