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J Reconstr Microsurg 2022; 38(07): 555-562
DOI: 10.1055/s-0041-1740925
Original Article

Perforator-Based Flap Reconstruction after Melanoma Resection: Evaluation of Oncological, Aesthetic, and Functional Outcomes

Beniamino Brunetti‡   *
1   Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
,
Rosa Salzillo  ‡   *
1   Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
,
Stefania Tenna
1   Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
,
Bruno Brunetti
2   Dermatology, Private Practice, Salerno, Italy
,
Mario Alessandri Bonetti
3   Department of Plastic, Reconstructive and Aesthetic Surgery, I.R.C.C.S. Istituto Galeazzi, University of Milan, Milan, Italy
,
Antonia Rivieccio
1   Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
,
Paolo Persichetti
1   Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
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Abstract

Background Evidence in literature about the best reconstructive approach after melanoma resection is controversial, with some authors advocating that tissue rearrangement flap techniques might hinder the early detection of local relapses. The aim of the present study is to evaluate oncological, aesthetic, and functional outcomes following melanoma reconstruction using pedicled perforator-based flaps.

Methods The authors reviewed all patients affected by melanoma treated during a 6-year period. Demographic data, tumor characteristics, and operative variables were evaluated. Locoregional recurrence was assessed with clinical and radiological follow-up. One-year postoperatively patients rated on a 5-point Likert scale the aesthetic and functional outcomes of the procedure. Three blind observers examined preoperative and 1-year postoperative photographs and rated the aesthetic outcome of the reconstructive procedure.

Results One-hundred sixty-five patients were treated with wide excision and delayed reconstruction, including pedicled perforator-based flaps in 70 patients (group A) and primary closure in 95 patients (group B). Mean Breslow thickness was 2.972 and 2.189 mm in group A and B, respectively. There was no statistically significant difference in locoregional recurrence (chi-squared test, p = 0.8333; Fisher's exact test, p > 0.9999) between the two groups. Group A reported a higher satisfaction with both the aesthetic (mean rating 4.390 in group A and 4.094 in group B) and functional (mean rating 4.732 in group A and 4.170 in group B) outcomes of the procedure, the latter being statistically significant (p = 0.0006).

Conclusion This series suggests that pedicled perforator-based flaps provide optimal aesthetic and functional outcomes in melanoma reconstruction without impairing the locoregional control of the disease.

Keywords

melanoma - perforator flaps - reconstruction

Data Availability Statement

The data that support the findings of this study are available from the corresponding author, upon request.


Disclosure Statement

No potential conflict of interest was reported by the authors. No funding was received for this work.


* These authors contributed equally to this work Presented at the 10th Congress of World Society for Reconstructive Microsurgery 2019 in Bologna, Italy and at the 68th Congress of the Italian Society of Plastic, Reconstructive and Aesthetic Surgery (SICPRE) 2019 in Palermo, Italy.




Publication History

Received: 26 July 2021

Accepted: 03 November 2021

Article published online:
17 December 2021

© 2021. Thieme. All rights reserved.

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