Ampliative Pedicled Abductor-hallucis-Myocutaneous Flap Repair Postoperative Defect of the Heel Malignant Melanoma in Thickness More than 4 mm

Peng Jun; Ma Hongliang

Abstract：Objective To evaluate the effectiveness of ampliative pedicled abductor-hallucis-myocutaneous flap to repair postoperative defect of the heel malignant melanoma in thickness more than 4 mm. Methods There were 6 patients with the mass type of heel skin malignant melanoma in thickness more than 4 mm,including 4 males and 2 females. Their age range from 46 to 83 years,with an average of 63 years old. And the course of disease ranged from 2 to 10 years;The area of primary tumor and its satellite nodules on heels were from 5 cm × 4 cm to 8 cm × 7 cm,all with ulceration. The maximum thickness of primary tumor range from 8 mm to 45 mm,with an average of 21. 1 mm. The area of defects were from 9 cm × 8 cm to 13 cm × 12 cm after wide exsection to expand 2 cm for these tumor. We repaired the defects of weightbearing area on heels with amplia-tive pedicled abductor-hallucis-myocutaneous flap about the size of 9 cm × 9 cm to 11 cm × 10 cm,and the remaining defects in the donor site and ambilateral non-weight bearing area on heels were repaired by split-thickness skin grafts from the homolater-al lower abdominal wall or the contralateral inguinal region. Results These musculocutaneous flaps and skin grafts survived,the wound healed well. The function and shape of the heels were satisfactory. The feeling of plantar medial halves were lost in 2 pa-tients,the medial forefoot plantar were hypoesthesia in 4 patients with 1 ~2 branches of medial plantar sensory nerve to be pre-served. Conclusion The ampliative pedicled abductor-hallucis-myocutaneous flap is suitable to repair the larger postoperative defect of heel malignant melanoma in thickness more than 4 mm,and may be chosen if metastases might ensconce in lower leg.