G. M. Winter1, J. D. Vargo2, J. M. Mammen3 1Unversity Of Kansas,School Of Medicine,Kansas City, KS, USA 2University Of Kansas,Department Of Plastic Surgery,Kansas City, KS, USA 3University Of Kansas,Department Of Surgery,Kansas City, KS, USA
Introduction:
Melanoma of the foot is often challenging to diagnose and treat due to its subungual, palmar and/or plantar locations. Patients with foot melanomas often present late, after significant radial spreading of malignant cells, and require more extensive resections. Following excision, reconstruction should reflect the functional and weight bearing nature of these locations. However, little is known about the reconstructive strategies needed for patients with melanomas of the foot. This study evaluates a series of patients with foot melanomas to identify disease thickness at time of diagnosis, extent of excision, reconstructive method, and functional status.
Methods:
After IRB approval, a retrospective review was performed to identify all patients with foot melanoma who underwent surgical excision at our institution between January 2010 and May 2016. Following identification, patient charts were reviewed for relevant demographic information, lesion location, tissue diagnosis, Breslow thickness, excision area, exposed structures, reconstructive method, functional status, complications, and survival. Reconstruction was performed either by the primary surgeon or in conjunction with plastic surgery and was determined based upon defect size, location, and exposed structures. Functional status was determined by the number of days between reconstruction and clearance for weight bearing activities.
Results:
34 patients met inclusion criteria (21 women and 14 men). Mean patient demographics and lesion characteristics were as follows: age 63±15, BMI 28.2±6.0, Breslow Thickness 2.0±1.8 mm, and excision area 35.5±25.6 cm2. Reconstructions were performed as follows: 11 Full thickness skin grafts (FTSG), 8 split thickness skin grafts (STSG), 7 Integra with STSG, 2 local flaps, 3 primary closures, 2 secondary healing, and 1 DIP amputation. 28 of 34 patients had complete data on functional status. Functional status recovery based on reconstruction were as follows: 23 days for FTSG, 17 for STSG, 29 for Integra with STSG, 35 for local flaps, 6 for primary closure, 8 for secondary healing, and 7 for amputation.
Cellulitis was seen following 3 STSG only, and P. aeruginosa infection was seen following 1 Integra and STSG reconstruction. One death occurred during the study period due to systemic progression of melanoma. Median follow up was 11 months.
Conclusion:
This study demonstrated the utility of a variety of reconstructive options following excision of foot melanoma. FTSG was most commonly used to reconstruct defects of plantar surfaces when there was a healthy wound bed with no exposed tendon or bone. When these structures are exposed, Integra placement with subsequent STSG is a viable option with good result. Functional status was regained first by STSG, then by FTSG, and finally by Integra and STSG. Ability to regain functional status is found to be dependent on reconstruction method.