Maker Ajay V, Iteld Lawrence
Division of Surgical Oncology, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA.
Section of Plastic Surgery, Department of Surgery, Advocate Illinois Masonic Medical Center, Chicago, IL, USA.
Ann Surg Oncol. 2015 Nov;22(12):4081-2. doi: 10.1245/s10434-015-4449-8. Epub 2015 Mar 7.
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.
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.
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.
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.
足底黑色素瘤广泛切除术后的重建颇具挑战。非无毛皮肤移植会导致组织缺失、角化过度、边缘瘢痕形成以及功能预后不佳，致使许多人采用各种皮瓣进行重建，这些方法技术要求高且失败率增加。无毛皮肤更适合承受压缩力和剪切力，为足底缺损提供更可靠的移植组织。
前瞻性收集数据。根据指征进行足底筋膜的广泛切除和前哨淋巴结活检。用负压敷料处理缺损，直至肉芽组织与周围皮肤齐平。从同侧非负重足背切取两片8/1000英寸的移植片。供皮区替换表皮/乳头层真皮，将较深的无毛真皮移植片固定于缺损处。该技术在多媒体文件中有展示。主要终点指标为移植片存活情况、并发症发生率和功能预后。
对连续的足部足底黑色素瘤患者准备进行无毛皮肤移植。平均Breslow厚度为3.9毫米（范围1.25 - 10；n = 5），缺损平均宽度为6.2厘米。平均随访304天。移植片存活率为100%，手术前后结果显示在媒体文件和图1中。受区无并发症，无明显色素减退或色素沉着，两个部位均无肥厚性瘢痕形成。1例患者供区出现血肿，但未延迟愈合或形成肥厚性瘢痕。无其他供区或受区并发症。美容效果极佳，几乎没有残留轮廓不规则。功能预后显示，无需矫形器即可100%恢复至基线活动水平，包括单板滑雪和帆板运动。
黑色素瘤切除术后足底缺损的无毛真皮移植极其可靠，美容效果极佳，供区并发症极少或无，功能预后良好。目前在我们机构，这些患者很少采用皮瓣手术。图1 使用当前技术进行分层无毛皮肤移植前后的足底黑色素瘤缺损情况。
