From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University; Department of Plastic and Reconstructive Surgery, Kansai Medical University; Department of Biomedical Engineering, National Cerebral and Cardiovascular Center Research Institute; Hiroshima University Hospital Center for Integrated Medical Research; Department of Plastic and Reconstructive Surgery, National Hospital Organization Kyoto Medical Center; and JINNO Medical Skin Clinic.
Plast Reconstr Surg. 2021 Jul 1;148(1):71e-76e. doi: 10.1097/PRS.0000000000008084.
Giant congenital melanocytic nevi are large skin lesions associated with a risk of malignant transformation. The authors developed a novel treatment to reconstruct full-thickness skin defects by combining an inactivated nevus as the autologous dermis and a cultured epidermal autograft. The first-in-human trial of this treatment was performed.
Patients with melanocytic nevi that were not expected to be closed by primary closure were recruited. The full-thickness nevus of the target was removed and inactivated by high hydrostatic pressurization at 200 MPa for 10 minutes. The inactivated nevus was sutured to the original site, and a cultured epidermal autograft was grafted onto it 4 weeks later. Patients were followed for up to 52 weeks.
Ten patients underwent reimplantation of the pressurized nevus, and one patient dropped out. The recurrence of nevus at 52 weeks was not detected by pathological diagnosis in any patients. The L* value at 52 weeks was significantly higher than that of the target nevus. One patient received skin grafting due to contracture of the reconstructed skin. The epithelized area of the reconstructed skin, as the percentage of the original target nevus, was 55.5 ± 19.4 percent at 12 weeks and 85.0 ± 32.4 percent at 52 weeks.
The inactivated nevus caused inflammation and contracture for several months. However, no recurrence was observed, and combination therapy using an inactivated nevus with a cultured epidermal autograft may therefore be a novel treatment of giant congenital melanocytic nevi.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
先天性巨大黑素细胞痣是一种与恶性转化风险相关的大型皮肤病变。作者开发了一种新的治疗方法，通过将灭活的痣作为自体真皮，并结合培养的表皮移植物来重建全厚皮肤缺损。该治疗方法的首次人体试验已经进行。
招募预计无法通过一期缝合闭合的黑素细胞痣患者。将目标的全厚痣用 200MPa 的高压水静压处理 10 分钟以使其灭活。将灭活的痣缝合到原始部位，4 周后移植培养的表皮移植物。对患者进行长达 52 周的随访。
10 名患者接受了加压痣的再植入，1 名患者退出。在任何患者中，病理诊断均未发现 52 周时痣的复发。52 周时 L*值明显高于目标痣。1 名患者因重建皮肤挛缩而接受皮肤移植。重建皮肤的上皮化面积占原始目标痣的百分比，在 12 周时为 55.5%±19.4%，在 52 周时为 85.0%±32.4%。
灭活的痣在几个月内引起炎症和挛缩。然而，未观察到复发，因此，使用灭活的痣与培养的表皮移植物联合治疗可能是先天性巨大黑素细胞痣的一种新的治疗方法。
临床问题/证据水平：治疗，IV。
