Closure of Melanoma Defects on the Sole of the Foot Using Glaborous Skin: The End of the Flap?
BACKGROUND
Plantar melanomas are a challenge to reconstruct after wide excision. Non-glaborous skin grafts have resulted in tissue loss, hyperkeratosis, marginal scarring, and poor functional outcomes, leading many to utilize various flaps for reconstruction that are technically demanding and associated with increased failure rates. Glaborous skin is better suited to withstand compressive and shear forces, and provides a more robust graft for plantar defects.


METHODS
Data were collected prospectively. Wide excision to the plantar fascia and sentinel lymph node biopsies were performed as indicated. The defect was treated with negative pressure dressings until granulation tissue was flush with surrounding skin. Two 8/1000 inch grafts were harvested from the ipsilateral non-weight-bearing instep. The epidermis/papillary dermis was replaced on the donor site and the deeper glaborous dermal graft was secured to the defect. This technique is demonstrated in the multimedia file. Primary endpoints were graft take, complication rates, and functional outcomes.


RESULTS
Consecutive plantar melanomas of the foot were prepared for glaborous grafting. Mean Breslow thickness was 3.9 mm (range 1.25-10; n = 5), and the average width of the defect was 6.2 cm. Mean follow-up was 304 days. The graft take was 100 %, and pre- and post-surgery results are displayed in the media file and Fig. 1. There were no recipient site complications, incidences of significant hypo- or hyperpigmentation, or hypertrophic scarring at either site. One patient experienced a donor site hematoma without delayed healing or hypertrophic scarring. There were no other donor or recipient site complications. Cosmesis was excellent, with minimal to no residual contour irregularity. Functional outcomes demonstrated a 100 % return to baseline activities without orthotics, including snowboarding and windsurfing.


CONCLUSIONS
Glabrous dermal grafting of plantar defects after melanoma resection is extremely reliable, affords excellent cosmesis, has minimal to no donor site morbidity, and results in excellent functional outcomes. Flaps are now rarely performed for these patients at our institution. Fig. 1 Plantar melanoma defect before and after split-thickness glaborous skin grafting using the current technique.
Division of Surgical Oncology, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA. amaker@uic.edu.
Ajay V
AV
Maker
Section of Plastic Surgery, Department of Surgery, Advocate Illinois Masonic Medical Center, Chicago, IL, USA.
Lawrence
L
Iteld
D005528:Foot; D005534:Foot Diseases / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008545:Melanoma / Q000473:pathology / Q000601:surgery*; D054843:Negative-Pressure Wound Therapy; D020127:Recovery of Function; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D016038:Skin Transplantation; D060053:Transplant Donor Site; D058106:Wound Closure Techniques