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

Abstract

Background Melanoma resection creates important soft tissues defects, which are difficult to manage when located on the weight-bearing heel and mid foot. There is little evidence on the use of the reverse-flow sural flap for this type of reconstruction. Objective This study reports our case series on the reconstructive management of the hind and mid-foot defects after melanoma resection using the reverse sural artery flap. Materials and Methods This is a retrospective study of four consecutive patients treated with resection of melanoma of the feet and reconstruction with reverse sural artery flap from 2006 to 2009. Results The mean age of the patients was 54 years, three were females, and one was male. Three of the defects were located on the weight-bearing heel, the other on the mid-foot dorsum. The melanomas were fully resected with wide margins. Three patients were reconstructed primarily, whereas one patient was reconstructed 4 weeks after the resective surgery. This series revealed 100% flap survival and there was no partial necrosis. Major complications were not observed. The four patients completely recovered the function of the affected limb. Conclusion The reverse sural flap is a viable option for the reconstruction of foot defects after melanoma resection.

Reverse sural artery fasciocutaneous flap in soft tissue reconstruction in lower extremity

“…16 Larrañaga et al In his study of sural artery flap after resection of melanoma around heel found flap survival in all the cases with no recurrence at 5 year follow up. 17 Present study had 2 cases of SCC and 1 case of malignant melanoma and flap healed well in all the cases. Majority of the cases in our study was soft tissue defect after RTA and flap did well except one case of failure due to necrosis.…”

Reverse sural flap – A feasible option for oncological defects of the lower extremity, ankle, and foot: Our experience from Northeast India

“…On reviewing the literature, we found that most of the RSAFs were done in cases of trauma and other nonmalignant causes[2526] though some authors[2127] have described it for melanoma of the foot. We have done RSAF for soft-tissue tumor and squamous cell carcinoma as well.…”

Reconstruction of plantar surgical defects with synthetic dermal matrix and split‐thickness skin grafts: A case series and functional podiatry outcomes

“…The main challenge when reconstructing surgical defects following the excision of acral melanoma on the foot is to preserve function. A range of flaps offering greater thickness and cushioning are frequently used in weight‐bearing areas 1,2 . Alternatives include secondary intention healing 3 and skin grafts 4 .…”

“…A range of flaps offering greater thickness and cushioning are frequently used in weightbearing areas. 1,2 Alternatives include secondary intention healing 3 and skin grafts. 4 Previous studies have suggested that dermal substitutes and STSGs may ease reconstruction by adding extra tissue to soften the impact on weightbearing areas.…”