title: The use of polytetrafluoroethylene to facilitate the vascular access in recurrent melanoma to limbs.
abstract: BACKGROUND
  Melanoma with recurrent loco-regional metastases to limbs often makes difficult a second surgical approach because of the adhesions affecting the vascular access. Our aim was to evaluate whether the placement of a polytetrafluoroethylene (PTFE) membrane around vessels might facilitate a surgical re-approach.
  
  
  METHODS
  We reported a case of a 64-year-old male with a melanoma on the left foot who developed in transit metastases after LND. While performing the inguinopelvic LND we coated the iliac vessels with PTFE patch to facilitate the vascular access in case of re-intervention for a ILP. In the second surgical approach we made a cutaneous incision in the left iliac region and we proceeded through the subcutaneous tissue until detection of iliac vessels, more clearly visible because of the PTFE patch fixed around vascular walls to minimize adhesions. We removed the PTFE coating and easily performed arteriotomy and venotomy for the completion of the ILP.
  
  
  CONCLUSIONS
  This case report seems to demonstrate the efficacy of a PTFE membrane applied in a patient around iliac vessels during inguinopelvic dissection, to reduce adhesion density. In fact this membrane provided a barrier to adhesions of the iliac vessels, decreasing the risk of vascular injury thereby facilitating a subsequent vascular access. Re-coating of the iliac vessels with PTFE could be preparatory to a better identification of the vascular structures in cases of a surgical re-approach.
  
  
  CONCLUSIONS
  The use of PTFE effectively simplifies the second approach to vessels in event of a melanoma metastasizing to limbs.
authors.affiliation: Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Ruggeri
authors.forename: Tiziana
authors.initials: T
authors.lastname: Camerini
authors.forename: Roberto
authors.initials: R
authors.lastname: Patuzzo
authors.forename: Andrea
authors.initials: A
authors.lastname: Maurichi
authors.forename: Riccardo
authors.initials: R
authors.lastname: Pirovano
authors.forename: Ilaria
authors.initials: I
authors.lastname: Mattavelli
authors.forename: Federica
authors.initials: F
authors.lastname: Crippa
authors.forename: Elena
authors.initials: E
authors.lastname: Tolomio
authors.forename: Daniele
authors.initials: D
authors.lastname: Moglia
authors.forename: Annabella
authors.initials: A
authors.lastname: Di Florio
authors.forename: Mario
authors.initials: M
authors.lastname: Santinami