Chouquet Luc, Boukari Feriel, Balaguer Thierry, Montaudié Henri, Camuzard Olivier, Lupon Elise
Plastic Surgery Department, Institut Universitaire Locomoteur et du Sport, Pasteur 2 Hospital, University Côte d'Azur, 06100 Nice, France.
Dermatology Department, L'Archet Hospital, University Côte d'Azur, 06100 Nice, France.
J Clin Med. 2025 Aug 22;14(17):5932. doi: 10.3390/jcm14175932.
: Historically, the treatment of subungual melanoma was based on amputation of the affected digit. However, extended wide local excision of the nail apparatus is now considered the conservative gold standard for in situ or minimally invasive forms. There are many after wide local excision reconstruction techniques, but few studies have objectively compared their results. The objectives were to carry out a systematic review of reconstruction after wide local excision reconstructions in the treatment of subungual melanoma. This systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. An exhaustive search was conducted in the PubMed (Medline), Embase, and Cochrane Library databases, up to July 2025. Articles reporting reconstructions after wide local excision for subungual melanoma of the fingers or toes were included. Clinical, technical, and outcome data were analyzed. The literature review comprised 24 articles on 373 patients, primarily those with in situ subungual melanoma. Reconstruction was most often performed using total skin grafts, sometimes combined with dermal matrices. Some authors used local or free flaps. Few studies used validated functional scores. Local recurrences were significant, affecting 18% of patients and requiring secondary amputation. Nail apparatus reconstructions are primarily indicated for in situ or minimally invasive subungual melanomas. Immediate reconstruction carries a risk of performing the reconstruction over residual tumor tissue, particularly in the case of invasive melanomas. Reconstructive techniques, such as full-thickness skin grafts and the use of dermal matrices, can provide satisfactory functional and aesthetic outcomes. However, objective evaluations of these results remain limited, and better standardization of clinical practice, along with prospective studies, is needed to refine long-term outcome assessment.
从历史上看，甲下黑色素瘤的治疗方法是对受影响的手指进行截肢。然而，现在认为对甲器进行扩大的广泛局部切除是原位或微侵袭性甲下黑色素瘤的保守金标准。广泛局部切除后有许多重建技术，但很少有研究客观地比较它们的结果。目的是对甲下黑色素瘤治疗中广泛局部切除后的重建进行系统评价。本系统评价遵循PRISMA（系统评价和Meta分析的首选报告项目）指南进行。截至2025年7月，在PubMed（Medline）、Embase和Cochrane图书馆数据库中进行了详尽的检索。纳入了报告手指或脚趾甲下黑色素瘤广泛局部切除后重建的文章。对临床、技术和结果数据进行了分析。文献综述包括24篇关于373例患者的文章，主要是原位甲下黑色素瘤患者。重建最常使用全厚皮片，有时结合真皮基质。一些作者使用局部或游离皮瓣。很少有研究使用经过验证的功能评分。局部复发很显著，影响了18%的患者，需要二次截肢。甲器重建主要适用于原位或微侵袭性甲下黑色素瘤。即刻重建存在在残留肿瘤组织上进行重建的风险，特别是在侵袭性黑色素瘤的情况下。重建技术，如全厚皮片移植和真皮基质的使用，可以提供令人满意的功能和美学效果。然而，对这些结果的客观评估仍然有限，需要更好地规范临床实践并开展前瞻性研究，以完善长期结果评估。
