Limb salvage surgery following resection of a melanoma: Foot and ankle reconstruction using cutaneous flaps

Abstract

Melanomas affect the foot and ankle region and are associated with a poor prognosis. The aim of the current study was to evaluate the functional and oncological outcomes of salvage surgery using cutaneous flaps for soft tissue reconstruction of the foot and ankle following the extended resection of a melanoma. A retrospective review was conducted to evaluate patients who presented with foot melanoma and underwent salvage surgery and defect reconstruction using three types of cutaneous flap (group S) or amputation (group A) between January 1999 and December 2010 at the First Hospital of Jilin University (Changchun, China). The postoperative mortality, surgical complications, functional outcomes and oncological outcomes were evaluated. Of the 21 patients, 11 were enrolled into group S and 10 were enrolled into group A. The median follow-up time of the patients was 58 months (range, 6–92 months). In group S, a reverse sural neurocutaneous island flap was used in six patients to perform the foot reconstruction, medial plantar flaps were used in four patients and lateral malleolus flaps were used in one patient. All 11 cutaneous flaps survived and provided satisfactory coverage. Only one cutaneous flap showed partial necrosis and required treatment comprising of debridement and regular changes to the wound dressing. The overall survival rate of patients was 65.0% and patients in the two groups experienced similar oncological outcomes. Salvage surgery with cutaneous flap reconstruction was found to be a reliable option for patients presenting with malignant melanoma of the foot and ankle.

Reconstruction using a perforator free flap after malignant melanoma resection of the ankle and foot

“…When looking at the overall 5‐year survival in our present case series, it was 73.2% which showed reconstruction has minimal effect in survival. Similar studies on foot and ankle melanoma that were treated with amputation report 5‐year survival rates that range from 52% to 71% . Thus, a limb salvaging reconstruction can be an alternative to amputation as a solution for cancer resection.…”

“…Although this study lacks a direct comparison to an amputation group, due to the potential ethical issues associated with defining a control group, it appears that wide excision followed by reconstruction with free flaps does not reduce the overall oncological survival or prognosis of patients with foot or ankle melanoma. This question may be answered by a study from Liu et al with 21 patients with foot or ankle melanoma lesions showed that the 11 patients who went wide excision followed by reconstruction with skin grafts had similar overall survival as the 10 patients who underwent amputation …”

“…Similar studies on foot and ankle melanoma that were treated with amputation report 5-year survival rates that range from 52% to 71%. [18][19][20][21][22][23] Thus, a limb salvaging reconstruction can be an alternative to amputation as a solution for cancer resection. However, this result is still much poorer than the overall 5-year survival for melanoma of any type or any location, which is 80-85%.…”

Reconstruction of Hind and Mid-Foot Defects after Melanoma Resection Using the Reverse Sural Flap: A Case Series

“…When reviewing the available literature, we can find many authors who recommend the use of the reverse sural flap, 4,[6][7][8][9] while others inform poor results.…”

“…However, many articles report a high incidence of partial flap necrosis. [6][7][8] In addition to that, some authors believe that the reverse sural flap is not suitable for weight-bearing heel reconstruction due to the numbness of the heel induced by the harvest of the flap. This has not been a problem in our patients.…”