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Background Medium-sized congenital melanocytic nevi (CMN) require surgical excision because of the risk of malignant transformation and aesthetic concerns. There are various possible reconstruction methods after excision, such as primary repair, skin graft, local flap, and composite graft. In this study, we used skin-fat composite grafts for reconstructing full-thickness skin defects and assessed the aesthetic outcomes. Methods Facial nevi excision plus skin-fat composite grafts were performed in 11 children (range, 3-16 years old). All grafts were harvested from the preauricular area on one or both sides; they included the epidermis, full-thickness dermis, and subcutaneous fat. All procedures were performed simultaneously. Standardized photographs were taken preoperatively and at a mean follow-up of 10.5 months. Viewing the photographs, four plastic surgeons rated the aesthetic outcomes of all patients using the following scale: 1, poor; 2, fair; 3, good; 4, very good; and 5, excellent. Results No patient was diagnosed with malignancy. There were no complications, such as graft loss, infection, or aesthetic problems that required surgical revision. All donor sites healed well and exhibited only minimal scarring. The aesthetic outcomes of skinfat composite grafts were outstanding with a mean score of 4.2 ± 0.4. Most patients and parents were highly satisfied with the results. Conclusions Skin-fat composite grafts provide good color match, texture, and contour. They are more tolerable, especially in children, because the technique involves simpler procedures and shorter operation times than local flaps. They may be the ideal option for facial defects after excision of medium-sized melanocytic nevi.

Skin-Fat Composite Grafts after Excisions of Medium Sized Congenital Melanocytic Nevi in Children