Wang Min, Xu Yuan, Wang Jin, Cui Lei, Wang Jun, Hu Xin-Bao, Jiang Hui-Qing, Hong Zhi-Jian, Yuan Si-Ming
Plastic Surgeon, Department of Plastic Surgery, Jinling Hospital, Nanjing School of Clinical Medicine, Southern Medical University, Nanjing, China.
Professor, Department of Plastic Surgery, Jinling Hospital, Nanjing School of Clinical Medicine, Southern Medical University, Nanjing, China.
J Foot Ankle Surg. 2018 Jul-Aug;57(4):689-693. doi: 10.1053/j.jfas.2017.12.004. Epub 2018 Apr 6.
Cutaneous melanoma is a highly malignant skin tumor, and in China, the planta pedis is a commonly involved site. The sites of plantar melanomas are a challenge to reconstruct after wide excision. Our experience with surgical management of melanomas was based on the 4 different anatomic subunits of the planta pedis. From January 1, 2002 to December 31, 2016, 35 patients who had had plantar melanoma had undergone surgical treatment in our clinic. The tumor locations were as follows: the toe in 6, the ball of the foot in 5, the arch in 15, and the heel in 9. Surgical management involved extended resection of the tumor, repair of defects with skin grafts or flaps, and inguinal lymphadenectomy. The skin flaps included a residual toe flap, an anterograde or retrograde medial plantar flap, and a retrograde sural neurocutaneous vascular flap. Of the 35 cases of flaps and skin grafts, 33 (94.29%) survived, and the wounds had healed by first intention. After a follow-up period of 6 months to 7 years, 24 patients (68.57%) were free of local and systemic disease and 30 patients (85.71%) were ambulatory using shoes, and all the flaps and skin grafts showed a good appearance. The personalized surgical treatments we used for melanoma in the planta pedis resulted in overall satisfactory outcomes and adequate disease clearance, and allowed the patients to resume normal lives. The function of the foot was maintained or restored to the greatest possible degree, and the patients' quality of life improved postoperatively.
皮肤黑色素瘤是一种高度恶性的皮肤肿瘤，在中国，足底是常见的受累部位。足底黑色素瘤切除术后的重建部位是一项挑战。我们对黑色素瘤手术治疗的经验基于足底的4个不同解剖亚单位。2002年1月1日至2016年12月31日，35例足底黑色素瘤患者在我们诊所接受了手术治疗。肿瘤位置如下：6例位于趾部，5例位于足球部，15例位于足弓，9例位于足跟。手术治疗包括肿瘤扩大切除、用皮片或皮瓣修复缺损以及腹股沟淋巴结清扫术。皮瓣包括残趾皮瓣、顺行或逆行足底内侧皮瓣以及逆行腓肠神经营养血管皮瓣。在35例皮瓣和皮片病例中，33例（94.29%）存活，伤口一期愈合。经过6个月至7年的随访，24例患者（68.57%）无局部和全身疾病，30例患者（85.71%）可穿着鞋子行走，所有皮瓣和皮片外观良好。我们对足底黑色素瘤采用的个性化手术治疗取得了总体满意的结果和充分的疾病清除效果，使患者能够恢复正常生活。足部功能得到最大程度的维持或恢复，患者术后生活质量得到改善。
