Malignant Melanoma of Heel, Middle Foot Sole, Plantar Forefoot and Immediate Reconstruction with Various Pedicle Locoregional flaps: Clinical Experience with 23 Cases

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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.