Treatment of giant congenital nevi with cryopreserved allogeneic skin and fresh autologous cultured epithelium.

Abstract

Giant congenital nevi, confluent over 10% to 52% of the body surface area, were treated in 5 pediatric patients with allogeneic skin and autologous cultured epithelium (ACE). The lesions were excised to the adipose tissue and the wound was covered with cryopreserved or fresh allografted skin. Later, the skin surface was abraded and ACE was applied. The size of the cultured graft ranged from 360 to 900 cm2 (average, 630 cm2). In 3 patients the wounds healed well. Allograft cryopreservation averaged 50 days. The average interval to ACE application after skin grafting was 10 days. Histological rejection was minimal. In 2 patients the cultured grafts did not take. The wounds were covered with split-thickness skin grafts. In one such patient, a fresh allograft was used. In the other, ACE was applied 27 days after skin grafting. Vigorous rejection reaction was observed. Cryopreservation of allogeneic skin may be important in the treatment of human leukocyte antigen-mismatch patients with giant nevi, and ACE should be applied within 10 days of skin grafting.