[Comparison study on different flaps in repairing defect caused by resection of cutaneous malignant melanoma in the heel region].

OBJECTIVE: To compare the clinical effectiveness of the medial plantar flap, the retrograde posterior tibial vascular flap, and the reverse sural neurocutaneous flap in repairing defect caused by resection of cutaneous malignant melanoma (CMM) in the heel region.

METHODS: The clinical data were retrospectively analysed from 24 patients with defect who had CMM in the heel region and were treated by radical excision and flap repairing between March 2007 and March 2010. Defects were repaired with the reverse sural neurocutaneous flaps of 8 cm x 7 cm-14 cm x 12 cm at size in 12 patients (group A), with the medial plantar flaps of 6 cm x 5 cm-8 cm x 7 cm at size in 7 patients (group B), and with the retrograde posterior tibial vascular flaps of 9 cm x 7 cm-15 cm x 13 cm at size in 5 patients (group C). There was no significant difference in gender, age, duration of illness, clinical stage, and size of CMM among 3 groups (P > 0.05). The donor site was sutured directly or by free skin graft.

RESULTS: No significant difference was found in the operation time and the intraoperative blood loss among 3 groups (P > 0.05). All skin flaps or grafts survived and wounds healed by first intention. The patients were followed up 1-3 years. The flaps had normal texture and color with no ulcer in 3 groups. At 1 year after operation, the sensory recovery rates of the flaps were 0, 100%, and 20% in groups A, B, and C, respectively, showing significant difference among 3 groups (P=0.001). The patients had normal appearance of heel and pain-free walking [10 (83%) in group A, 6 (86%) in group B, and 4 (80%) in group C] of heel region, showing no significant difference among 3 groups (Chi(2)=40.000, P=0.135). Heel pain existed in weightbearing walking of 3 groups, and there were significant differences in visule analogue scale (VAS) score (P < 0.05). There was no significant difference in range of motion of ankle joint among 3 groups (P > 0.05). Except 1 patient of relapse in group A at 1 month after operation, no relapse was observed in the other patients during follow-up.

CONCLUSION: The medial plantar flap, the retrograde posterior tibial vascular flap, and the reverse sural neurocutaneous flap can achieve the good clinical effectiveness in treating heel defect caused by the resection of CMM. And the medial plantar flap is the first choice in small skin defect of heel area.