人工真皮治疗先天性巨痣的研究进展
Advances in the Treatment of Congenital Giant Nevi with Artificial Dermis
摘要: 先天性黑色素细胞痣(CMN)是常见的先天性皮肤色素性病变，其中巨型CMN因病变范围广、切除后缺损大，修复重建难度高。传统皮瓣及自体植皮等方法存在供区损伤大、手术次数多、瘢痕挛缩明显等局限。人工真皮作为真皮替代材料，可为创面提供三维支架、促进血管化与真皮再生，在巨痣切除后创面修复中的应用日益广泛。本文综述人工真皮的组成结构与修复机制、常见产品特点，总结其在巨型先天性黑色素细胞痣及其他疾病中的应用模式、疗效与并发症，并展望其未来发展方向，以期为临床个体化修复策略提供参考。
Abstract: Congenital melanocytic nevus (CMN) is a common congenital pigmented skin lesion, and giant CMN remains challenging in reconstructive surgery because of the large defect after resection. Conventional approaches such as flaps and autologous skin grafting are limited by donor-site morbidity, multiple operations and obvious scar contracture. Artificial dermis, as a dermal substitute, provides a three-dimensional scaffold that promotes vascularization and dermal regeneration, and has been increasingly used in wound reconstruction after giant nevus resection. This review summarizes the structure, repair mechanism and common products of artificial dermis, discusses its application patterns, efficacy and complications in giant congenital melanocytic nevus and other diseases, and outlines future directions, aiming to provide references for individualized reconstructive strategies.
文章引用：石稞心, 郭能强. 人工真皮治疗先天性巨痣的研究进展[J]. 临床医学进展, 2026, 16(9): 1865-1875. https://doi.org/10.12677/acm.2026.1693229

参考文献

[1] 王嘉厅. 先天性巨大黑素痣的发病机制及其靶向治疗的研究进展[J]. 中国美容医学, 2022, 31(11): 189-193.
[2] Alikhan, A., Ibrahimi, O.A. and Eisen, D.B. (2012) Congenital Melanocytic Nevi: Where Are We Now? Part I. Clinical Presentation, Epidemiology, Pathogenesis, Histology, Malignant Transformation, and Neurocutaneous Melanosis. Journal of the American Academy of Dermatology, 67, 495.e1-495.e17.
https://doi.org/10.1016/j.jaad.2012.06.023
[3] Castilla, E.E., Dutra, M.D.G. and Orioli-Parreiras, I.M. (1981) Epidemiology of Congenital Pigmented Naevi: I. Incidence Rates and Relative Frequencies. British Journal of Dermatology, 104, 307-315.
https://doi.org/10.1111/j.1365-2133.1981.tb00954.x
[4] Vourc’h-Jourdain, M., Martin, L. and Barbarot, S. (2013) Large Congenital Melanocytic Nevi: Therapeutic Management and Melanoma Risk: A Systematic Review. Journal of the American Academy of Dermatology, 68, 493-498.e14.
https://doi.org/10.1016/j.jaad.2012.09.039
[5] Krengel, S., Hauschild, A. and Schäfer, T. (2006) Melanoma Risk in Congenital Melanocytic Naevi: A Systematic Review. British Journal of Dermatology, 155, 1-8.
https://doi.org/10.1111/j.1365-2133.2006.07218.x
[6] Kinsler, V.A., O’Hare, P., Bulstrode, N., Calonje, J.E., Chong, W.K., Hargrave, D., et al. (2017) Melanoma in Congenital Melanocytic Naevi. British Journal of Dermatology, 176, 1131-1143.
https://doi.org/10.1111/bjd.15301
[7] Kadonaga, J.N. and Frieden, I.J. (1991) Neurocutaneous Melanosis: Definition and Review of the Literature. Journal of the American Academy of Dermatology, 24, 747-755.
https://doi.org/10.1016/0190-9622(91)70115-i
[8] Bett, B.J. (2006) Large or Multiple Congenital Melanocytic Nevi: Occurrence of Neurocutaneous Melanocytosis in 1008 Persons. Journal of the American Academy of Dermatology, 54, 767-777.
https://doi.org/10.1016/j.jaad.2005.10.040
[9] Masnari, O., Schiestl, C., Rossler, J., Gutlein, S.K., Neuhaus, K., Weibel, L., et al. (2013) Stigmatization Predicts Psychological Adjustment and Quality of Life in Children and Adolescents with a Facial Difference. Journal of Pediatric Psychology, 38, 162-172.
https://doi.org/10.1093/jpepsy/jss106
[10] 李越. 先天性巨痣的治疗进展[J]. 中国美容医学, 2020, 29(6): 181-185.
[11] Ibrahimi, O.A., Alikhan, A. and Eisen, D.B. (2012) Congenital Melanocytic Nevi: Where Are We Now? Part II. Treatment Options and Approach to Treatment. Journal of the American Academy of Dermatology, 67, 515.e1-515.e13.
https://doi.org/10.1016/j.jaad.2012.06.022
[12] Burke, J.F., Yannas, I.V., Quinby, W.C., Bondoc, C.C. and Jung, W.K. (1981) Successful Use of a Physiologically Acceptable Artificial Skin in the Treatment of Extensive Burn Injury. Annals of Surgery, 194, 413-428.
https://doi.org/10.1097/00000658-198110000-00005
[13] Yannas, I.V. and Burke, J.F. (1980) Design of an Artificial Skin. I. Basic Design Principles. Journal of Biomedical Materials Research, 14, 65-81.
https://doi.org/10.1002/jbm.820140108
[14] Yannas, I.V., Burke, J.F., Gordon, P.L., Huang, C. and Rubenstein, R.H. (1980) Design of an Artificial Skin. II. Control of Chemical Composition. Journal of Biomedical Materials Research, 14, 107-132.
https://doi.org/10.1002/jbm.820140203
[15] Heimbach, D., Luterman, A., Burke, J., Cram, A., Herndon, D., Hunt, J., et al. (1988) Artificial Dermis for Major Burns: A Multi-Center Randomized Clinical Trial. Annals of Surgery, 208, 313-320.
https://doi.org/10.1097/00000658-198809000-00008
[16] Suzuki, S., Matsuda, K., Isshiki, N., Tamada, Y., Yoshioka, K. and Ikada, Y. (1990) Clinical Evaluation of a New Bilayer “Artificial Skin” Composed of Collagen Sponge and Silicone Layer. British Journal of Plastic Surgery, 43, 47-54.
https://doi.org/10.1016/0007-1226(90)90044-z
[17] Ryssel, H., Gazyakan, E., Germann, G. and Öhlbauer, M. (2008) The Use of Matriderm® in Early Excision and Simultaneous Autologous Skin Grafting in Burns—A Pilot Study. Burns, 34, 93-97.
https://doi.org/10.1016/j.burns.2007.01.018
[18] Chang, D.K., Louis, M.R., Gimenez, A. and Reece, E.M. (2019) The Basics of Integra Dermal Regeneration Template and Its Expanding Clinical Applications. Seminars in Plastic Surgery, 33, 185-189.
https://doi.org/10.1055/s-0039-1693401
[19] Taupin, P., Gandhi, A. and Saini, S. (2023) Integra® Dermal Regeneration Template: From Design to Clinical Use. Cureus, 15, e38608.
https://doi.org/10.7759/cureus.38608
[20] van der Veen, V.C., van der Wal, M.B.A., van Leeuwen, M.C.E., Ulrich, M.M.W. and Middelkoop, E. (2010) Biological Background of Dermal Substitutes. Burns, 36, 305-321.
https://doi.org/10.1016/j.burns.2009.07.012
[21] Gurtner, G.C., Werner, S., Barrandon, Y. and Longaker, M.T. (2008) Wound Repair and Regeneration. Nature, 453, 314-321.
https://doi.org/10.1038/nature07039
[22] Bao, P., Kodra, A., Tomic-Canic, M., Golinko, M.S., Ehrlich, H.P. and Brem, H. (2009) The Role of Vascular Endothelial Growth Factor in Wound Healing. Journal of Surgical Research, 153, 347-358.
https://doi.org/10.1016/j.jss.2008.04.023
[23] Penn, J.W., Grobbelaar, A.O. and Rolfe, K.J. (2012) The Role of the TGF-β Family in Wound Healing, Burns and Scarring: A Review. International Journal of Burns and Trauma, 2, 18-28.
[24] Gill, S.E. and Parks, W.C. (2008) Metalloproteinases and Their Inhibitors: Regulators of Wound Healing. The International Journal of Biochemistry & Cell Biology, 40, 1334-1347.
https://doi.org/10.1016/j.biocel.2007.10.024
[25] Xue, M. and Jackson, C.J. (2015) Extracellular Matrix Reorganization during Wound Healing and Its Impact on Abnormal Scarring. Advances in Wound Care, 4, 119-136.
https://doi.org/10.1089/wound.2013.0485
[26] Kashimura, T., Nagasaki, K., Horigome, M., Yoshida, K. and Soejima, K. (2021) Selection of Artificial Dermis for Shortening Treatment Period: Integra versus Pelnac. Plastic and Reconstructive Surgery—Global Open, 9, e3599.
https://doi.org/10.1097/gox.0000000000003599
[27] Kubo, K. and Kuroyanagi, Y. (2003) Development of a Cultured Dermal Substitute Composed of a Spongy Matrix of Hyaluronic Acid and Atelo-Collagen Combined with Fibroblasts: Fundamental Evaluation. Journal of Biomaterials Science, Polymer Edition, 14, 625-641.
https://doi.org/10.1163/156856203322274897
[28] Barcot, Z., Inga, D.B., Zupancic, B. and Bacalja, V. (2017) Treating Giant Congenital Nevus with Integra Dermal Regeneration Template in a 9-Year-Old Girl. The International Journal of Lower Extremity Wounds, 16, 143-145.
https://doi.org/10.1177/1534734617702259
[29] Kopp, J., Magnus Noah, E., Rübben, A., Merk, H.F. and Pallua, N. (2003) Radical Resection of Giant Congenital Melanocytic Nevus and Reconstruction with Meek-Graft Covered Integra Dermal Template. Dermatologic Surgery, 29, 653-657.
https://doi.org/10.1046/j.1524-4725.2003.29157.x
[30] 陈积洪, 李天武, 傅跃先, 等. 手术治疗229例儿童黑色素痣临床效果观察[J]. 中国美容医学, 2015, 24(7): 1-6.
[31] Makkawi, K.W., Beaineh, P.T., Emsieh, S.E., Chrabieh, E.E. and Ibrahim, A.E. (2025) Reconstruction of Back Defect from Giant Congenital Melanocytic Nevus Using Dermal Substitute Matrix. Plastic and Reconstructive Surgery - Global Open, 13, e6487.
https://doi.org/10.1097/gox.0000000000006487
[32] Koenen, W., Felcht, M., Vockenroth, K., Sassmann, G., Goerdt, S. and Faulhaber, J. (2011) One‐Stage Reconstruction of Deep Facial Defects with a Single Layer Dermal Regeneration Template. Journal of the European Academy of Dermatology and Venereology, 25, 788-793.
https://doi.org/10.1111/j.1468-3083.2010.03863.x
[33] Damaraju, S.M., Mintz, B.R., Park, J.G., Gandhi, A., Saini, S. and Molnar, J.A. (2022) Skin Substitutes with Noncultured Autologous Skin Cell Suspension Heal Porcine Full‐Thickness Wounds in a One‐Stage Procedure. International Wound Journal, 19, 188-201.
https://doi.org/10.1111/iwj.13615
[34] Niimi, Y., Baba, K., Tsuchida, M. and Takeda, A. (2022) A Histological Evaluation of Artificial Dermal Scaffold Used in Micrograft Treatment: A Case Study of Micrograft and NPWT Performed on a Postoperative Ulcer Formation after Tumor Resection. Medicina, 58, Article 73.
https://doi.org/10.3390/medicina58010073
[35] Pauchot, J., Elkhyat, A., Rolin, G., Mac, S., Grumblat, A., Fotso, A., et al. (2013) Dermal Equivalents in Oncology: Benefit of One-Stage Procedure. Dermatologic Surgery, 39, 43-50.
https://doi.org/10.1111/dsu.12044
[36] Akin, M., Akgün, A.E. and Tuncer, H.B. (2024) Treatment of a Congenital Melanocytic Giant Naevi at Age 39 Using Split-Thickness Skin Graft over an Artificial Dermal Scaffold through 2-Step Operation: A Novel Technique and Literature Review. Eplasty, 24, e43.
[37] Lv, Z., Wang, Y., Chen, J., Zhang, Q. and Zhao, H. (2025) Pelnac® Artificial Dermis Assisted by Vacuum Sealing Drainage for Treatment of Severe Avulsion Injuries of the Fingers. Journal of Orthopaedic Surgery and Research, 20, Article No. 136.
https://doi.org/10.1186/s13018-025-05547-z
[38] Mahabbat, N., Alohaideb, N., Aldaghri, F., Alshomer, F. and Murad, M.A. (2018) Functional Subunit Reconstruction of Giant Facial Congenital Melanocytic Nevi in Children with the Use of Matriderm and Skin Graft: Surgical Experience and Literature Review. Eplasty, 18, e30.
[39] Bodmer, E., Osinga, R., Fritsche, E. and Hug, U. (2012) Integra® Zur Einzeitigen Defektdeckung Nach Tumorresektion im Gesichtsbereich. Handchirurgie·Mikrochirurgie·Plastische Chirurgie, 44, 355-359.
https://doi.org/10.1055/s-0032-1316380
[40] Hunter, J.E., Teot, L., Horch, R. and Banwell, P.E. (2007) Evidence‐Based Medicine: Vacuum‐Assisted Closure in Wound Care Management. International Wound Journal, 4, 256-269.
https://doi.org/10.1111/j.1742-481x.2007.00361.x
[41] Jeschke, M.G., Rose, C., Angele, P., Füchtmeier, B., Nerlich, M.N. and Bolder, U. (2004) Development of New Reconstructive Techniques: Use of Integra in Combination with Fibrin Glue and Negative-Pressure Therapy for Reconstruction of Acute and Chronic Wounds. Plastic and Reconstructive Surgery, 113, 525-530.
https://doi.org/10.1097/01.prs.0000100813.39746.5a
[42] Sullivan, T., Smith, J., Kermode, J., Mclver, E. and Courtemanche, D.J. (1990) Rating the Burn Scar. Journal of Burn Care & Rehabilitation, 11, 256-260.
https://doi.org/10.1097/00004630-199005000-00014
[43] Draaijers, L.J., Tempelman, F.R.H., Botman, Y.A.M., Tuinebreijer, W.E., Middelkoop, E., Kreis, R.W., et al. (2004) The Patient and Observer Scar Assessment Scale: A Reliable and Feasible Tool for Scar Evaluation. Plastic and Reconstructive Surgery, 113, 1960-1965.
https://doi.org/10.1097/01.prs.0000122207.28773.56
[44] Groos, N., Guillot, M., Zilliox, R. and Braye, F.M. (2005) Use of an Artificial Dermis (Integra®) for the Reconstruction of Extensive Burn Scars in Children. about 22 Grafts. European Journal of Pediatric Surgery, 15, 187-192.
https://doi.org/10.1055/s-2004-821215
[45] Schiestl, C., Stiefel, D. and Meuli, M. (2010) Giant Naevus, Giant Excision, Eleg(i)ant Closure? Reconstructive Surgery with Integra Artificial Skin® to Treat Giant Congenital Melanocytic Naevi in Children. Journal of Plastic, Reconstructive & Aesthetic Surgery, 63, 610-615.
https://doi.org/10.1016/j.bjps.2009.01.050
[46] Prezzavento, G.E., Whyte, L.M.O., Calvi, R.N.J., Rodríguez, J.A. and Taupin, P. (2025) Use of Cadaveric Skin Allograft and Integra Dermal Regeneration Template to Manage Deep Lower Limb Injuries. Journal of Wound Care, 34, 239-248.
https://doi.org/10.12968/jowc.2023.0230
[47] Frame, J.D., Still, J., Lakhel-LeCoadou, A., Carstens, M.H., Lorenz, C., Orlet, H., et al. (2004) Use of Dermal Regeneration Template in Contracture Release Procedures: A Multicenter Evaluation. Plastic and Reconstructive Surgery, 113, 1330-1338.
https://doi.org/10.1097/01.prs.0000111883.93604.85
[48] Kumbla, P.A., Yuen, J.C. and Tait, M.A. (2015) Applying a Dermal Regenerative Template in Management of Congenital Melanocytic Nevi of the Hand. Plastic and Reconstructive Surgery—Global Open, 3, e515.
https://doi.org/10.1097/gox.0000000000000483
[49] Ha, J., Park, T.H., French, M.M. and Gociman, B. (2026) Long-Term Outcomes of Neonatal Hand Sarcoma Reconstruction with Integra and Full-Thickness Skin Grafting. Plastic and Reconstructive Surgery—Global Open, 14, e7831.
https://doi.org/10.1097/gox.0000000000007831
[50] Dantzer, E. and Braye, F.M. (2001) Reconstructive Surgery Using an Artificial Dermis (Integra): Results with 39 Grafts. British Journal of Plastic Surgery, 54, 659-664.
https://doi.org/10.1054/bjps.2001.3684
[51] Soong, L.C., Bencivenga, A. and Fiorillo, L. (2022) Neonatal Curettage of Large to Giant Congenital Melanocytic Nevi under Local Anesthetic: A Case Series with Long-Term Follow up. Journal of Cutaneous Medicine and Surgery, 26, 149-155.
https://doi.org/10.1177/12034754211057751
[52] Ott, H., Krengel, S., Beck, O., Böhler, K., Böttcher‐Haberzeth, S., Cangir, Ö., et al. (2019) Multidisciplinary Long‐Term Care and Modern Surgical Treatment of Congenital Melanocytic Nevi—Recommendations by the CMN Surgery Network. JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 17, 1005-1016.
https://doi.org/10.1111/ddg.13951
[53] Corradino, B., Di Lorenzo, S., Leto Barone, A.A., Maresi, E. and Moschella, F. (2010) Reconstruction of Full Thickness Scalp Defects after Tumour Excision in Elderly Patients: Our Experience with Integra® Dermal Regeneration Template. Journal of Plastic, Reconstructive & Aesthetic Surgery, 63, e245-e247.
https://doi.org/10.1016/j.bjps.2009.05.038
[54] Sun, B.K., Siprashvili, Z. and Khavari, P.A. (2014) Advances in Skin Grafting and Treatment of Cutaneous Wounds. Science, 346, 941-945.
https://doi.org/10.1126/science.1253836
[55] Lee, V., Singh, G., Trasatti, J.P., Bjornsson, C., Xu, X., Tran, T.N., et al. (2014) Design and Fabrication of Human Skin by Three-Dimensional Bioprinting. Tissue Engineering Part C: Methods, 20, 473-484.
https://doi.org/10.1089/ten.tec.2013.0335

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