Kato Hiroshi, Kano Shinji, Yoshimitsu Maki, Nakagawa Yua, Yasui Yukiko, Nakamura Motoki, Morita Akimichi
Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
J Dermatol. 2024 Dec;51(12):1641-1645. doi: 10.1111/1346-8138.17398. Epub 2024 Sep 4.
Plantar malignant melanoma is largely managed surgically, particularly in its early stages. However, the plantar region has a lower survival rate of skin grafts than other regions. Furthermore, complete wound healing occurs over a long period of time, postoperatively. Thus, in this study, we retrospectively analyzed the use of skin grafts to reconstruct skin defects, as postoperative complications of plantar malignant melanoma. Forty-nine patients, (23 males, 26 females; mean age 70.4-years) underwent excisional surgery for plantar malignant melanoma at our hospital, between March 2018 and December 2022. The time from initial surgery to wound healing was analyzed, using a multivariate Cox proportional hazards model, to identify related factors. We excluded cases with lesions in non-weight-bearing areas and cases with segmental layer grafts, based on multivariate analysis, to eliminate bias when comparing a one-step resection and reconstruction technique to resection followed by waiting for granulation to occur before reconstruction. Patients were categorized into three cohorts. The first and second cohorts had undergone one-step and two-step skin grafting, respectively. Patients in the third cohort underwent secondary intention healing without skin grafting. The results revealed that the factors associated with wound-healing time included a defect size of >1800 mm, in addition to two-step and split-thickness skin grafting. Therefore, Kaplan-Meier curves were constructed across the three cohorts, based on the data of 37 patients. Nine cases of non-weight-bearing areas and three cases of split-thickness skin grafts were excluded from the original total of 49 patients. The median times from the initial surgery to wound healing were 14.6, 12.0, and 21.9 weeks for the one- and two-step skin grafting and secondary intention healing cohorts, respectively. A statistically significant difference in the treatment time between the skin grafting and secondary intention healing cohorts was observed (p < 0.001) Moreover, a statistically significant difference in the treatment time between the one- and two-step skin grafting cohorts was noted (p = 0.046). Thus, two-step skin grafting after surgical treatment for plantar malignant melanoma may shorten the overall treatment duration by allowing granulation to occur.
足底恶性黑色素瘤主要通过手术治疗，尤其是在早期阶段。然而，足底区域皮肤移植的存活率低于其他区域。此外，术后伤口完全愈合需要很长时间。因此，在本研究中，我们回顾性分析了作为足底恶性黑色素瘤术后并发症的皮肤移植用于重建皮肤缺损的情况。2018年3月至2022年12月期间，我院49例患者（23例男性，26例女性；平均年龄70.4岁）接受了足底恶性黑色素瘤切除手术。使用多变量Cox比例风险模型分析从初次手术到伤口愈合的时间，以确定相关因素。基于多变量分析，我们排除了非负重区域有病变的病例和分层皮片移植的病例，以消除在比较一步切除重建技术与切除后等待肉芽形成再进行重建时的偏差。患者被分为三个队列。第一和第二队列分别接受了一步和两步皮肤移植。第三队列的患者接受了无皮肤移植的二期愈合。结果显示，除了两步和中厚皮片移植外，与伤口愈合时间相关的因素还包括缺损面积>1800平方毫米。因此，根据37例患者的数据，在三个队列中绘制了Kaplan-Meier曲线。原始的49例患者中排除了9例非负重区域病例和3例中厚皮片移植病例。一步和两步皮肤移植以及二期愈合队列从初次手术到伤口愈合的中位时间分别为14.6周、12.0周和21.9周。皮肤移植和二期愈合队列之间的治疗时间存在统计学显著差异（p<0.001）。此外，一步和两步皮肤移植队列之间的治疗时间也存在统计学显著差异（p=0.046）。因此，足底恶性黑色素瘤手术治疗后进行两步皮肤移植可通过促进肉芽形成来缩短总体治疗时间。
