We report the case of a 7-year-old male patient presenting with pigmentation due to right flank and congenital hallucinous a giant flank back with a maximum diameter of 30 x 19 cm, irregular edges, areas of greater
1.
The eventual malignancy of a possible malignancy, we performed together with the family surgical treatment without delay, for which we obtained the corresponding informed consent of the family and the authorization of our transplant committee
In the first viable surgical intervention, we read the complete excision of the nephrotic syndrome by means of an ultrasonic scalpel, which allowed uniform excision in the plane below the subdermal vascular plexus.
The resulting defect was covered with Integra® and to ensure its immobility, we used a system of negative pressure therapy VAC.® (Vacuum Assisted Closure KCl Clinic Spain S.L.)
In the same intervention, a healthy skin biopsy was performed on one of the margins, which was sent according to protocol to the Community Center for Blood and Tissues (CCST) of the Principality of Asturias (Spain), 5 autologous skin.
Postoperative care consisted of weekly cures under sedation and maintenance of a portable VAC® system, which allowed early hospital discharge.
Anatomy confirmed that it was a rare pathology with a predominantly intradermal edge, with foci of deep junctional compounds and non-lateral junctional affections studied, and also with focal points.
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At 3 weeks, we performed the second surgical time scheduled for removal of the silicone sheet of Integra® observing an almost complete grip.
That same day, we coordinated the arrival of the cultured skin sheets from the CCST, which were sent to us by means of histoacryl points to a solid support (6), individually wrapped on themselves.
We covered the defect completely with cultivated skin, immobilizing it with its own support by staples.
In turn, we immobilized everything again with the VAC® system, -50mmHg continuous pressure, following the same pattern of outpatient care.
Cultured skin prevailed initially in 90%, providing that it seemed a stable epithelium and tended to converge in the bloody areas.
Two weeks after the first sowing, we covered the remaining bloody areas with a new patch of cultivated skin and the same fixation system.
In the immediate postoperative period of this second sowing, in the first healing performed at 4 days, we observed abundant suppuration in the wound and fixation staples, although successive cultures were negative.
From the first week, the collaboration of the patient and the family allowed us to use vacuum therapy and establish topical cures on an outpatient basis, facilitating observation of the tape, vaseline gauze and impregnated anticompresses.
Approximately a month and a half we had to definitively rule out the survival of skin cultures, so it was necessary to make definitive coverage by self-injectors of ultrafine thickness, without meshing the right thigh.
This time the coverage was complete, showing one year after surgery a scar of excellent quality and elasticity and good aesthetic result, without evidence of persistence of the lesion or recurrence.
