Takaya Kento, Kato Tatsuya, Ishii Tatsuyuki, Sakai Shigeki, Okabe Keisuke, Aramaki-Hattori Noriko, Asou Toru, Kishi Kazuo
Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan.
Tokyo Cosmetic Surgery Clinic, Tokyo, Japan.
Plast Reconstr Surg Glob Open. 2021 Jan 26;9(1):e3380. doi: 10.1097/GOX.0000000000003380. eCollection 2021 Jan.
Cultured epidermal transplantation (JACE) is performed for giant congenital melanocytic nevus (GCMN), but there are few reports on its postoperative course and surgical content or indications. We aimed to investigate the postoperative course of GCMN patients undergoing cultured epidermal autograft transplantation and compare the outcomes between 2 nevus tissue resection methods.
Twelve GCMN patients aged 0 months to 8 years and 9 months were included in this single-center case series study. Cultured epidermal autograft transplantation was performed at 19 sites of the patients' extremities and trunks, after excision of the nevus either by using an electric dermatome, which we initially used in 2017, or by curettage with a sharp spoon and use of a hydrosurgery system (Versajet), which we started performing in 2018. Univariate and multivariate analyses were performed for factors associated with postoperative hypertrophic scar formation.
In all cases, >90% of the grafts survived, and the dark brown color of the nevus was reduced. Average postoperative observation period was 16.5 months. Hypertrophic scar formation was observed postoperatively at 9 wound sites out of the 12 sites with GCMN removed with a dermatome and at only 1 site with GCMN removed by curettage with use of a hydrosurgery system. In the univariate and multivariate analyses, hypertrophic scar formation was associated with age at surgery.
In cultured epidermal autograft transplantation for GCMN, nevus tissue removal at an early age by curettage with use of a hydrosurgery system can provide good results while reducing complications, including recurrence and hypertrophic scar formation.
培养表皮移植术（JACE）用于治疗巨大先天性黑素细胞痣（GCMN），但关于其术后病程、手术内容及适应证的报道较少。我们旨在研究接受培养表皮自体移植术的GCMN患者的术后病程，并比较两种痣组织切除方法的效果。
本单中心病例系列研究纳入了12例年龄在0个月至8岁9个月的GCMN患者。在患者的四肢和躯干的19个部位进行了培养表皮自体移植术，痣切除采用两种方法，一种是我们于2017年开始使用的电动取皮刀，另一种是2018年开始采用的用锐匙刮除并使用水刀手术系统（Versajet）。对与术后肥厚性瘢痕形成相关的因素进行单因素和多因素分析。
所有病例中，>90%的移植物存活，痣的深褐色减退。术后平均观察期为16.5个月。在使用电动取皮刀切除GCMN的12个部位中，有9个伤口部位术后出现了肥厚性瘢痕形成，而在使用水刀手术系统刮除GCMN的部位中，只有1个部位出现了肥厚性瘢痕形成。在单因素和多因素分析中，肥厚性瘢痕形成与手术年龄相关。
在GCMN的培养表皮自体移植术中，早期使用水刀手术系统刮除痣组织可取得良好效果，同时减少包括复发和肥厚性瘢痕形成在内的并发症。
