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

Abstract

The use of free flaps to close defects after cancer resection can help preserve maximal extremity length and function. This approach does not have negative impact on overall outcome and further provide an increased quality of life with better function. Reconstruction using free flaps should be considered primarily when defects cannot be covered by conventional methods.

Two-team-approached free flap reconstruction for plantar malignant melanoma: An observational (STROBE-compliant) trial

“…[23] A limitation of this paper is that it is not a controlled study. Of course, the operating time is reduced compared to the 1-team approach, but compared to the published literatures, [15,31] the results of the present study are not significantly different in the areas of revision surgery, wound problem, regional recurrence, and distant metastasis. In addition, no recurrence is observed at surgical site such as donor sites, sentinel lymph nodes, and lymph node dissection sites other than the primary lesion, which is the major concern in 2-team approach surgery.…”

“…[5,6,8,9] It is challenging to surgically resect melanomas of the distal lower extremity, especially the foot or ankle, because it requires wide excisions that can yield large defects. [31] If reliable reconstruction with preservation of foot function cannot be guaranteed following ablative surgery, oncologic surgeons tend to conduct conservative surgeries and use smaller excision margins, which can affect oncologic outcomes, especially local failure rate. [37] In other words, surgical resection with appropriate margins results in low local recurrence rates [9] and the best chances of long-term survival and progression-free survival.…”

“…Thus, free flap approaches are useful reconstruction choices for salvage treatment of the foot and ankle. [ 31 , 32 ] Fasciocutaneous free flaps provide ample volume supply and satisfactory outcomes functionally and aesthetically, [ 23 ] but the reconstruction of oncologic foot defects using fasciocutaneous perforator flaps is rare and the outcomes of such surgery remain poorly elucidated. [ 15 , 33 ]…”

When free flaps are not the first choice: is the distally based peroneus brevis still an option for foot and ankle reconstruction in the era of microsurgery?

“…Other than in the proximal knee region and the upper and middle third of the lower leg, where a variety of proximally based local pedicled flaps are available, the lower third and foot and ankle region demand either free flaps or reversed pedicled flaps [11,61,62] . Various modifications of the sural and peroneusbrevis flaps have been described to optimize the outcome and minimize complications [63][64][65][66][67] .…”

Principles of Orthoplastic Surgery for Lower Extremity Reconstruction: Why Is This Important?

“…These principles hold true whether reconstructing a traumatic wound, a defect following oncologic surgery, nonhealing diabetic wounds, or a wound with infected/exposed hardware. 1,[19][20][21] For instance, following oncologic surgery, reconstructive goals include preserving function, maintaining a reasonable aesthetic outcome, and providing adequate lower soft tissue coverage to allow for adjuvant therapy (e.g., radiation). 1 Particularly when considering oncologic outcomes following resection of lower extremity tumors, avoiding adequate margins to close a defect by simpler means is no longer a concern when an orthoplastic team approach is used.…”