Abstract:

Objective

To explore the effect of medial plantar flap combined with peroneal artery perforator flap in repairing the wound after resection of giant malignant melanoma on heel.

Methods

The clinical data of 9 patients with giant malignant melanoma on heel who met the inclusion and exclusion criteria and were admitted to the Department of Burn and Wound Repair， Hanzhong Central Hospital from May 2015 to May 2023 were retrospectively analyzed， including 7 males and 2 females， aged from 46 to 72 years.All patients were enlarged tumor resection， and the surgical margin was negative， and the area of wound ranged from 8 cm×9 cm to 12 cm×14 cm.The medial plantar flap was used to reconstruct the weight-bearing area，the flap area ranged from 5 cm×6 cm to 9 cm×11 cm.The peroneal artery perforator flap was used to cover the non-weight-bearing area， the flap area ranged from 10 cm×18 cm to 13 cm×24 cm.The survival of the flap and skin grafts were recorded.At the last follow-up， the appearance of the flap was recorded， the twopoint discrimination distance of the flap was measured，and the foot function was evaluated by Maryland foot function score.

Results

The flaps of 8 patients survived well， the peroneal artery perforator flap of one patient was partially necrotic， which was reconstructed with full thickness free skin graft after debridement.The patients were followed up for 6-36 months， no local recurrence or distant transfer was found， the flaps were not bloated， the texture and color were good.The medial plantar flap had normal sensation and the twopoint discrimination distance was 3-6 mm.The peroneal artery perforator flap had a two-point discrimination distance of 8-10 mm.The residual scar of skin graft in the donor site had no significant effect on foot function.The Maryland foot function score was （93.2±6.8）， 7 patients were excellent and 2 patients were good.The patients were satisfied with the appearance， and the function of the lower limb was not affected.

Conclusion

The medial plantar flap combined with peroneal artery perforator flap used in repairing the wounds after the resection of giant malignant melanoma on heel， can not only meet the functional and sensory recovery of the weight-bearing area，but also meet the needs of the skin flap coverage and appearance of the non-weight-bearing area of the heel.The postoperative appearance and function are good， and the method is simple and safe.

Key words: Malignant melanoma, Medial plantar flap, Peroneal artery perforator flap