Arch Hand Microsurg.  2022 Sep;27(3):240-246. 10.12790/ahm.22.0005.

Long-term results of wide local excision with concurrent venous free flap reconstruction in subungual melanoma

Affiliations
  • 1Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
  • 2Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine, Seoul, Korea

Abstract

Purpose
Wide local excision (WLE) has been used as an alternative to amputation for preserving the length of the digit in subungual melanoma (SUM). For reconstruction, a free flap could be a more suitable option than a skin graft or a local flap. We investigated the clinical value of WLE with concurrent venous free flap reconstruction in SUM located on the finger and toe.
Methods
Seventeen patients underwent WLE with a concurrent arterialized venous free flap between January 2011 and December 2015. Venous flaps were harvested from the forearm or foot dorsum and inset using a through- or against-valve type.
Results
The mean tumor area was 1.3±0.9 cm2, and the mean resection margin was 5.6±2.3 mm. In histologic analyses, the mean tumor thickness was 1.2±1.1 mm. The mean duration of the follow-up period was 75.5 months. Three patients had local recurrence and one patient had distant metastasis. Reconstruction of the fingers and toes using a venous flap was effective and could be performed without major complications. Patients were satisfied with the functional and aesthetic results.
Conclusion
WLE provides an acceptable local control rate and offers a safe and conservative alternative for the treatment of SUM of the fingers and toes. Concurrent venous free flaps could be a desirable option for aesthetic and functional reconstruction.

Keyword

Malignant melanoma; Subungual melanoma; Wide local excision; Venous free flap

Figure

  • Fig. 1. Patient (case 7) with subungual melanoma on the left third finger. (A) Preoperative clinical photograph. (B) En-bloc excision of the tumor and nail complex with a 5-mm margin. (C) A venous flap harvested from the volar side of the left forearm was anastomosed with one digital artery and two digital veins. (D) Natural contour of the reconstructed finger without any complications at the 8-month follow-up. Written informed consent was obtained for publication of accompanying images.

  • Fig. 2. Patient (case 8) with subungal melanoma on the right first toe. (A) Preoperative clinical photograph. (B) After inset of a venous flap harvested from the dorsal side of the right foot to allow reversed blood flow with the against-valve type. (C) Clinical photograph of a skin defect that occurred at the center of the flap due to trauma 3 months after surgery. (D) Completely healed flap without further treatment at a 5-year follow-up after debridement and skin grafting for the skin defect. Written informed consent was obtained for publication of accompanying images.


Cited by  1 articles

Diagnosis and treatment of subungual melanoma
Joon Seok Oh, Byung Jun Kim
Arch Hand Microsurg. 2023;28(3):125-136.    doi: 10.12790/ahm.22.0072.


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