Журнал хирургии и анестезии

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Reconstruction of Calcaneous Region after Melanoma Excision with Extended Medial Plantar Flap: Case Report

Paulo Rocha de Pádua Júnior, Fernando Henrique Novaes, Vinicius Costa Souza, Guilherme Barreiro Cardinali

Introduction: Acral melanoma has some distinct characteristics of the other melanoma subtypes as a higher frequency of local involvement. This leads to surgical treatment with wide margins of deep and peripheral resection, causing significant tissue loss with frequent exposure of the bone ends. The medial plantar flap uses the skin of the plantar cavus area, an ideal tissue for reconstruction of the calcaneous area.
Objective: To report a case of calcaneal region reconstruction with medial plantar flap after melanoma excision.
Case report: Patient, female, had a lesion diagnosed on the right foot in medical consultation due to unicomycosis. There were no complaints related to the injury. The biopsy revealed malignant acral lentiginous melanoma with a Breslow thickness of 1.9 mm, surgical margins free of neoplastic involvement and T2NxMx pathological staging. After the anatomopathological result, a 2 cm margin magnification was programmed with extensive resultant defect. The plastic surgery team opted for immediate reconstruction with ipsilateral extended medial plantar flap and graft of the donor area.
Conclusion: The medial plantar flap provides adequate coverage for the calcaneal region, resistant to local inherent traumas of the region, with low morbidity in the donor area, good esthetic effect, rare complications, easy reproducibility and satisfactory functional recovery. It can be extended including a lateral plantar artery depending on the case, besides being able to remove the graft from the flap itself to avoid an increase in morbidity in other areas.