DOI QR코드

DOI QR Code

Serratus Anterior Fascia Free Flap for Functional Surgery of Subungual Melanoma: Case Series and Literature Review

  • Soo Jin Woo (Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine) ;
  • Sung Tack Kwon (Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine) ;
  • Byung Jun Kim (Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine)
  • 투고 : 2024.02.14
  • 심사 : 2024.10.09
  • 발행 : 2025.03.15

초록

Background In addressing subungual melanoma, this study presents the efficacy of wide excision followed by reconstruction using a serratus anterior fascial free flap. Methods The study covers four patients treated between 2017 and 2020 for melanoma in the great toe or thumb, highlighting the successful application of the flap and split-thickness skin graft over exposed distal phalanx cortical bone. Results The Breslow depths of the melanomas ranged from 0.2 to 6 mm, with four to seven lymph nodes dissected per patient, revealing no metastasis. Over follow-ups of 26 to 57 months, no local or distant recurrences were observed. The serratus anterior fascial free flaps, averaging 2.1 mm in thickness, precisely matched defect depths, negating the need for further debulking. Conclusion This technique offered satisfactory functional and aesthetic outcomes, proposing the serratus anterior fascial free flap as a viable alternative for acral region reconstruction in subungual melanoma cases after wide excision.

키워드

참고문헌

  1. Swetter SM, Thompson JA, Albertini MR, et al. NCCN Guidelines® Insights: melanoma: cutaneous, version 2.2021. J Natl Compr Canc Netw 2021;19(04):364–376 https://doi.org/10.6004/jnccn.2021.0018
  2. Dunphy L, Morhij R, Verma Y, Pay A. Missed opportunity to diagnose subungual melanoma: potential pitfalls!. BMJ Case Rep 2017;2017:bcr2016218785 https://doi.org/10.1136/bcr-2016-218785
  3. Amin K, Edmonds K, Fleming A, Powell B. Subungual malignant melanoma–re-learning the lesson. BMJ Case Rep 2011;2011:bcr1020103422 https://doi.org/10.1136/bcr.10.2010.3422
  4. Cochran AM, Buchanan PJ, Bueno RA Jr, Neumeister MW. Subungual melanoma: a review of current treatment. Plast Reconstr Surg 2014;134(02):259–273 https://doi.org/10.1097/PRS.0000000000000529
  5. Sureda N, Phan A, Poulalhon N, Balme B, Dalle S, Thomas L. Conservative surgical management of subungual (matrix derived) melanoma: report of seven cases and literature review. Br J Dermatol 2011;165(04):852–858 https://doi.org/10.1111/j.1365-2133.2011.10477.x
  6. High WA, Quirey RA, Guillén DR, Munõz G, Taylor RS. Presentation, histopathologic findings, and clinical outcomes in 7 cases of melanoma in situ of the nail unit. Arch Dermatol 2004;140(09):1102–1106 https://doi.org/10.1001/archderm.140.9.1102
  7. Foucher G, Khouri RK. Digital reconstruction with island flaps. Clin Plast Surg 1997;24(01):1–32 https://doi.org/10.1016/S0094-1298(20)32579-7
  8. Zhang JF, Wang L, Hao R-Z, Huo YX, Yang HY, Hu YC. Treatment of fingertip avulsion injuries using two periposition pedicled flaps. J Plast Reconstr Aesthet Surg 2019;72(04):628–635 https://doi.org/10.1016/j.bjps.2018.12.051
  9. Brown RE, Zook EG, Russell RC. Fingertip reconstruction with flaps and nail bed grafts. J Hand Surg Am 1999;24(02):345–351 https://doi.org/10.1053/jhsu.1999.0345
  10. Hong JP, Choi DH, Suh H, et al. A new plane of elevation: the superficial fascial plane for perforator flap elevation. J Reconstr Microsurg 2014;30(07):491–496
  11. YamamotoT, Yamamoto N, Fuse Y, Kageyama T, Sakai H, Tsukuura R. Subdermal dissection for elevation of pure skin perforator flaps and superthin flaps: the dermis as a landmark for the most superficial dissection plane. Plast Reconstr Surg 2021;147(03):470–478 https://doi.org/10.1097/PRS.0000000000007689
  12. Narushima M, Iida T, Kaji N, et al. Superficial circumflex iliac artery pure skin perforator-based superthin flap for hand and finger reconstruction. J Plast Reconstr Aesthet Surg 2016;69(06):827–834 https://doi.org/10.1016/j.bjps.2016.03.005
  13. Motta A, López C, Acosta A, Peñaranda C. Subungual melanoma in situ in a Hispanic girl treated with functional resection and reconstruction with onychocutaneous toe free flap. Arch Dermatol 2007;143(12):1600–1602 https://doi.org/10.1001/archderm.143.12.1600
  14. Lee KT, Park BY, Kim EJ, et al. Superthin SCIP flap for reconstruction of subungual melanoma: aesthetic functional surgery. Plast Reconstr Surg 2017;140(06):1278–1289 https://doi.org/10.1097/PRS.0000000000003881
  15. Woo SJ, Ma IZ, Kwon ST, et al. Long-term results of widelocal excision with concurrent venous free flap reconstruction in subungual melanoma. Archives of Hand and Microsurgery. 2022;27(03):240–246 https://doi.org/10.12790/ahm.22.0005
  16. Kim JH, Lee KT. Reconstruction of circumferential fingertip defect using free superficial palmar branch of the radial artery flap: report of two cases. Microsurgery 2024;44(01):e31109 https://doi.org/10.1002/micr.31109
  17. Ulrich D, Fuchs P, Bozkurt A, Pallua N. Free serratus anterior fascia flap for reconstruction of hand and finger defects. Arch Orthop Trauma Surg 2010;130(02):217–222 https://doi.org/10.1007/s00402-009-0845-5
  18. Buehler MJ, Pacelli L, Wilson KM. Serratus fascia "sandwich" free-tissue transfer for complex dorsal hand and wrist avulsion injuries. J Reconstr Microsurg 1999;15(05):315–320 https://doi.org/10.1055/s-2007-1000108
  19. Kim BJ, Kim J, Hu J, Kwak Y, Kwon ST. Functional surgery for subungual melanoma: surgical tips based on histological analysis of 21 cadavers. Dermatol Surg 2022;48(01):7–11 https://doi.org/10.1097/DSS.0000000000003232