Reconstruction of large wounds using a combination of negative pressure wound therapy and punch grafting after excision of acral lentiginous melanoma on the foot

Abstract

Melanoma in darker-pigmented individuals often develops in an acral lentiginous fashion on the foot. After surgical removal of a tumor at this site, repair of the wound can be challenging. This is because there is an insufficient local skin pool and lack of mobility of the skin in this area. Moreover, functional aspects such as walking and weight bearing should be considered. We performed a combination treatment of negative pressure wound therapy (NPWT) and punch grafting on 15 patients, after wide excision of acral lentiginous melanomas on the foot, and compared these to 26 patients who underwent either secondary intention healing (SIH, n = 13) or NPWT (n = 13) alone. The punch grafting with NPWT group showed significantly shorter healing times than those of the other two groups. Evaluation of completely healed wounds using the Vancouver Burn Scar Assessment Scale revealed that the punch grafting group had mean values better, or comparable, to the SIH or NPWT group in four of the five scales (except pigmentation). As for complications, only one patient developed a wound infection after punch grafting. Further, by utilizing NPWT for fixation of punch grafts, it was possible to treat all subjects as outpatients after punch grafting. These results show that a combination treatment of NPWT and punch grafting is an excellent therapeutic option for post-wide excision wounds on the feet, with significantly shortened healing times and favorable cosmetic outcomes.

Oncologic feasibility for negative pressure wound therapy application in surgical wounds: A meta‐analysis

“…One study used incisional NPWT, 13 one study used NPWT on the artificial dermis, 32 and the other four studies used NPWT directly on the wounds. 12,14,22,33 Despite these limitations, we conclude that tumour recurrence after NPWT was not significantly different compared with conventional non-negative pressure wound care. NPWT is associated with a lower risk of wound complications, shortened hospitalisation duration, and wound closure time.…”

“…26,32 In the two studies involving acral melanoma surgical wounds, NPWT use was associated with significantly shorter time to complete re-epithelialization, and favourable cosmetic outcomes. 12,33 Furthermore, NPWT devices allow for ambulatory treatment, earlier hospital discharge or even same-day discharge. A wound study of cost-utility analysis clearly demonstrated a clear cost benefit to NPWT.…”

Dermal substitutes: an alternative for the reconstruction of large full-thickness defects in the plantar surface

“…Surgical alternatives regularly employed in this location are split or full-thickness skin grafting, secondary intention healing with or without negative pressure, application of skin substitutes, local flaps, and microvascular techniques. 3 , 4 , 5 , 6 , 7 , 8 The individualized decision of which procedure or product to use depends on patients’ specifics such as wound size, age, comorbidities, social, psychological, and economic factors. Postoperative complications may include hematoma, wound infection, thromboembolism, flap loss, and in exceptional cases, progression to amputation.…”

Role of customised negative-pressure wound therapy in the integration of split-thickness skin grafts: A randomised control study

“…Other causes of wounds reported in literature for which NPWT has been used for the integration of STSG include diabetic wounds,[13] hidradenitis cystica and amputation stump wounds,[5] wounds following excision of irradiated extremity sarcomas,[14] necrotising fasciitis and associated pubic bone osteomyelitis,[15] Fournier's gangrene,[16] chronic leg ulcers,[17] over punch grafts after excision of melanoma feet[18] and over radial forearm free flap donor sites. [19] NPWT has also been used for securing skin grafts to microvascular free flaps[20] and for the vulvovaginal reconstruction with skin grafts.…”