Author(s): Adeela H.Khan, Mamoon Rashid, Saad-ur-Rehman Sarwar, Farhan A. Eitezaz, Aqsa Akhtar, Noshi Khan, Sakina Malik
Pages: 1-11 |
Objective: To present our experience of cases of malignant melanoma of various regions of sole of foot and Immediate Reconstruction with various pedicle locoregional flaps Study Design: Descriptive case series Place and Duration of study: Study was conducted at Shifa International Hospital, Islamabad from August, 2009 to December, 2018. Patients and Methods: Total of 23 patients underwent biopsy proven melanoma excision from sole of foot. The defect location was on heel in 17 patients, the middle plantar foot in 4 and forefoot in 2 patients. Excision margins were taken according to Breslow thickness. All the patients included in surgery had immediate reconstruction using pedicle locoregional flaps. Synchronous inguinal lymph node dissection was done in 15 cases and delayed lymph node dissection was done in 4 cases. Results: Total of 14 sensate medial plantar artery flaps for defects of heel and mid-foot were performed, 6 single stage neurocutaneous sural flaps were done for defects of heel, and in one case a combination of sural and medial plantar artery flap was used. The medial plantar and fillet flaps healed well and the color matches were excellent. None of the patients complained about the donor-site scar. All patients were satisfied with the functional results and cosmetic appearance. Positive margin was seen in one of the heel melanoma on definitive histopathology, re-resection with advancement of sural flap was done Conclusion: Immediate reconstruction of various defects after acral lentiginous melanoma extirpation can be attempted with acceptable oncological safety. Majority of the defects can be reconstructed with loco regional flaps without relying on complex reconstruction procedures involving microsurgery with the added benefit of like with like reconstruction.
1. Dzwierzynski WW. Managing malignant melanoma. PlastReconstr Surg. 2013;132:446e–460e.
2. Narayan D, Ariyan S. Surgical management of the primary melanoma. Clin Plast Surg. 2000;27 :409–419
3. Breslow A. Thickness, cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma. Ann Surg. 1970;172:902-908.
4. Zell JA, Cinar P, Mobasher M, et al: Survival for patients with mvas1ve cutaneous melanoma among ethnic groups: The effects of socioeconomic status and treatment. J Clin Oncol 26:66-75, 2008
5. Byrd KM, Wilson DC, Hoyler SS, et al: Advanced presentation of melanoma m African Americans. J Am Acad Dermatol 50:21-24; discussion 142-143, 2004
6. Johnson TM, Smith JW II, Nelson BR, Chang A. Current therapy for cutaneous melanoma.
7. Stalkup JR, Orengo IF, Katta R: Controversies in acrallentiginous melanoma. DermatolSurg 11:1051-1059, 2002
8. Phan A, Touzet S, Dalle S, et al: Acrallentiginous melanoma: Histopathological prognostic features of 121 cases. Br J Dermatol 157 :311-318, 2007
9. Erdemir A, Sirimamilla PA, Halloran JP, van den Bogert AJ. An elaborate data set characterizing the mechanical response of the foot. J Biomech Eng. 2009;131:094502.
10. Bach AD, Leffler M, Kneser U, Kopp J, Horch RE. The versatility of the distally based peroneus brevis muscle flap m reconstructive surgery of the foot and lower leg. Ann Plast Surg. 2007;58:397–404.
11. Peek A, Giessler GA. Functional total and subtotal heel reconstruction with free composite osteofasciocutaneous groin flaps of the deep circumflex iliac vessels. Ann
Plast Surg. 2006;56:628-634.
12. Roblin P, Healy CM. Heel reconstruction with a medial plantar V-Y flap. PlastReconstr Surg. 2007;119:927-932.
13. Shanahan RE, Gingrass RP. Medial plantar sensory flap for coverage of heel defects. PlastReconstr Surg. 1979;64:295-298.
14. Ulusal BG, Lin YT, Ulusal AE, Lin CH, Yen JT. Reconstruction of foot defects with free lateral arm fasciocutaneous flaps: Analysis of fifty patients. Microsurgery 2005;25:581-588.
15. Yiicel A, Senyuva C, Aydin Y, Cinar C, Giizel Z. Soft-tissue reconstruction of sole and heel defects with free tissue transfers. Ann Plast Surg. 2000;44:259-268; discussion 268-269.
16. Baker GL, Newton ED, Franklin JD. Fasciocutaneous island flap based on the medial plantar artery: Clinical applications for leg, ankle, and forefoot. PlastReconstr
Surg. 1990;85:47-60.
17. Morrison WA, Crabb DM, O’Brien BM, Jenkins A. The instep of the foot as a fasciocutaneous island and as a free flap for heel defects. PlastReconstr Surg. 1983;72:56-65.
18. Yang D, Yang JF, Morris SF, Tang M, Nie C. Medial plantar artery perf orator flap for soft-tissue reconstruction of the heel. Ann Plast Surg. 2011;67:294–298
19. Balch CM, Gershenwald JE, Soong SJ, et al. Final version of 2009 AJCC melanoma staging and classification. J ClinOncol. 2009;27: 6199-6206
20. Bradford PT, Goldstein AM, McMaster ML, Tucker MA. Acrallentiginous melanoma: Incidence and survival patterns in the United States, 1986-2005. Arch Dermatol. 2009; 145 :427–434.
21. Pflugfelder A, Weide B, Eigentler TK, et al. Incisional biopsy and melanoma prognosis: Facts and controversies. Clin Dermatol. 2010;28:316–318.
22. Martin RC II, Scoggins CR, Ross MI, et al. Is incisional biopsy of melanoma harmful? Am J Surg. 2005;190:913-917
23. Gu JH, Jeong SH. Radical resection of a venous malformation in middle finger and immediate reconstruction usmg medial plantar artery perforator flap: A case report. Microsurgery 2012;32:148-152.
24. Koshima I, Narushima M, Mihara M, et al. Island medial plantar artery perforator flap for reconstruction of plantar defects. Ann Plast Surg. 2007;59:558-562
25. Donski PK, Fogdestam I. Distally based fasciocutaneous flap from the sural region: A preliminary report. Scand J Plast Reconstr Surg. 1983;17:191-196.
26. Masquelet AC, Romana MC, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: Anatomic study and clinical experience in the leg.PlastReconstr Surg. 1992;89:1115-1121.
27. Ayyappan T, Chadha A. Super sura lneuro fasciocutaneous flaps in acute traumatic heel reconstructions. Plast Reconstr Surg. 2002;109:2307-2313.
28. Tharayil J, Patil RK. Reverse peroneal artery flap for large defects of ankle and foot: A reliable reconstructive technique. Indian J Plast Surg. 2012;45:45-52.
All published material becomes the sole property of the Pakistan Journal of Plastic Surgery, copyrighted by the Pakistan Association of Plastic Surgeons (PAPS). By submitting an article or brief communication, all authors agree to these conditions.
During the submission process, all authors have required to complete a copyright transfer agreement, “Author Consent form” By completing the copyright transfer agreement, you are transferring copyright of figures, tables, videos, and the content of the manuscript to the Pakistan Association of Plastic Surgeons (PAPS).
If you do not wish to or cannot transfer copyright of some or all of your content, please contact the editorial office at pjpspakistan@gmail.com