Clinical Comparative Study Of Two Kinds Of Skin Flaps In Repairing Skin Defect After Heel Malignant Melanoma Resection

Objective:T Objective:To investigate the effect of medial plantar flap（MPF）and reverse sural neurocutaneous flap（RSNF）in repairing the skin defect of heel malignant melanoma（MM）after excision.The clinical efficacy was compared and analyzed to provide reference for clinical treatment.Materials and methods:A total of 19 patients with heel MM admitted to our department from January 2016 to December 2021 were retrospectively studied,and a total of 18 cases met the criteria.The patients were divided into RSNF group（group A）and MPF group（group B）according to the different flaps taken by surgical methods.Group A:There were 9 cases in total,including 7 males and 2 females,4cases on the left side and 5 cases on the right side;the age at treatment was 36-74years old,with an average age of 63.22±11.55 years old.According to the AJCC staging criteria,there was 1 case of stage I,7 cases of stage II,and 1 case of stage III.Among them,the ipsilateral ilioinguinal groin of the stage III patient was enlarged,and the mass could be palpated.After surgery,3 inguinal lymph nodes were excised and sent for examination,and the pathological results were all metastasis.One case was diagnosed as MM by local excision in a local hospital and was admitted to our hospital.Group B:a total of 9 cases,including 8 males and 1 female,4 cases on the left side and 5 cases on the right side;the age of treatment was 41 to 84 years old,with an average age of 62.67±12.63 years old.There were 4 cases in stage I and 5cases in stage II,of which 1 case was diagnosed as MM by local excision in a local hospital and was admitted to our hospital.Most of the patients in the two groups complained of a black mass on the heel that had gradually increased recently,or may be accompanied by exudation.Expansion of the skin lesions was performed by surgery,and the return of pathological examination was MM.The second operation was performed with pedicled skin flap transfer,and the pathological examination was carried out.The follow-up time was 3 to 73 months.The defect diameter,defect area,and flap area were compared between the two groups.The AOFAS ankle function score was used to evaluate the clinical efficacy,and SPSS 19.0（Chicago,IL,USA）software was used for statistical analysis.RESULTS:The test results showed that there were no significant differences in gender（p=1.000）,affected side（p=1.000）,age（p=0.626）,and between the two groups.There was no significant difference in the length of operation（h）,the total days of hospitalization（d）and the days of hospitalization（d）after flap surgery between the two groups（p>0.05）.The defect diameter（cm）and flap area（cm~2）in the two groups were p<0.05,which was statistically significant.Among the postoperative complications,2 of the 9 patients in group A developed bilateral lower extremity intermuscular venous thrombosis（subacute stage）,1 patient developed tension blisters after skin flap surgery,slow venous reflux occurred at the distal end of the skin flap,and the distal end of the skin flap developed slowly.The color of the skin flap was slightly darker,and the symptoms were relieved after administration of drugs to improve circulation and continuous dressing changes.2 cases had redness and swelling around the wound and recovered to normal after dressing change.In group B,all 9 wounds healed by first intention,and no wound infection occurred.1 patient had low protein symptoms after operation,which was caused by the patient’s weight loss and the usual diet of vegetarian food plus postoperative stress.AOFAS:AOFAS evaluation in group A:7 cases were excellent,1 case was good,and 1 case was fair.The excellent and good rate was 88.9%,with an average score of90.78±9.23.AOFAS evaluation in group B:excellent in 7 cases,good in 2 cases.The excellent and good rate was 100%,and the average score was 95.56±4.27.The scores of the two groups were compared with p>0.05,and the difference was not statistically significant.Conclusion:（1）Both surgical methods can repair the heel defect very well.The medial plantar flap is more similar in structure to the heel skin,and the sensory function is preserved after repair.The postoperative effect is more obvious,but less Not applicable for large defect areas.（2）The repairable area of the sural nerve retrograde flap is larger, but the incision is larger,and the reconstruction of sensory function needs to rely on nerve anastomosis.