A 72-year-old female reported to the department complaining of blackish-brown pigmentation below the left eyelid present since birth which had grown to attain the present size (3cm x 3cm). The pigmentation was suspected to be a melanotic nevus. The excision of the nevus with 4mm of clear wound margin, reconstruction with a Wolfe’s graft from the neck under local anaesthesia was planned.

Under aseptic conditions the patient was painted and draped. The border of the nevus was marked using marking ink and 4mm free margin surrounding it was marked. Local anaesthetic was infiltrated in the surroundings of the lesion. The incision was placed along the free margins, blunt dissection was carried out and the entire nevus was excised. The recipient site was measured using a calliper and these measurements were transferred on to the sterile graft site on the lower border of right neck. A full thickness graft or a Wolfe’s graft was harvested from the donor site. Haemostasis at the donor site was obtained using sutures. Double layer closure was done at the donor site with 4-0 vicryl and 5-0 prolene sutures in simple interrupted manner. The graft was transfixed to the recipient site with 5-0 prolene sutures in continuous locking manner. Bactigrass dressing and Bolster (autoclaved sponge) were secured over the graft site with 5-0 prolene suture. Both the donor and recipient site received closed dressings. The excised specimen was sent for Histopathology. Post operative instructions were given and the patient was asked to revert back after 7days for suture removal and follow up. On the 8^th post operative day the bolster sutures were removed and wound margins were cleaned with spirit and betadine, histopathology reported it to be a congenital melanotic nevus. The patient was asked to revert back after every 2 days for follow up. On the 10^th post operative day the wound was examined, there was a haematoma collection beneath the skin. The haematoma was evacuated by placing nicks over the skin layer of graft. Due to poor patient compliance on the 15^th post operative day there was haematoma collection beneath the skin graft. The skin over the graft had turned black and stony hard. The haematoma was evacuated and the skin was peeled off. On examination the subcutaneous tissue of the graft was accepted along the 2/3 of the periphery of the wound with raw wound bed at the centre of the recipient site. The wound was cleaned with surgical spirit and betadine and closed dressing with Bactigrass was placed every alternative day. On the 20^th postoperative day, the periphery along with centre of the wound showed ingrowth of granulation tissue suggestive of healing. The sutures at the periphery of the wound were removed. Every 3 days the dressing was changed for the patient. On 45^th post operative day the recipient site had healed completely with normal skin covering over it. Despite the fact that we lost the graft's superficial skin, there was no ectropion in our situation.