手术治疗足跟底部皮肤黑色素瘤12例临床分析

Surgical Treatment for Plantar Heel Melanoma：Clinical Analysis of 12 Cases

目的：探讨基于循证医学策略的足跟底皮肤恶性黑色素瘤手术治疗的方法与效果。方法：回顾国外黑色素瘤治疗进展的相关文献，依照黑色素瘤瘤体厚度确定足跟底黑色素瘤手术切除范围，并根据术后足跟底软组织缺损深度在足底内侧切取相应组织量的带蒂足底内侧区皮瓣转位修复缺损；供区创面游离中厚皮片覆盖。结果：术后12例皮瓣均成活。随访12个月，所有皮瓣受区功能与外形良好，受区无溃疡发生。随访至30个月时，9例皮瓣外形与功能稳定，1例出现局部黑色素瘤复发，2例死于肿瘤复发及广泛转移。结论：根据瘤体厚度决定跟底黑色素瘤切除范围的循证医学手术策略切实可行；根据需要在不同层面切取组织量不等的足底内侧区皮瓣，可以满足跟底不同厚度的缺损修复。

Objective：This study was made to investigate the surgical technique for plantar heel melanomas based on evidence - based medicine （EBM） and evaluate its outcomes. Methods： Progress of related surgical strategies on melanoma treatment were reviewed in English literature. Twelve volar heel malignant melanomas in 12 cases were removed with the excision margins determined by the tumor depth. Pedicled flaps at various planes from the medial plantar area were elevated to repair the heel defects. Split - thickness skin graft was used to repair the donor sites. Patients were discouraged to ambulate with the affected heels during the 1 st postoperative month, and then started with partial weight- bearing from the 2rd week on. After discharge, the patients were followed up from 12 to 30 months. Results： All the 12 flaps survived after operation. At 12 - month follow up, all flaps functioned well with aesthetically acceptable appearance. No ulcer was found at the recipient sites. At 30 - month follow up 10 patients were still alive, with one developing recurrent local melanoma. However, the other subjects presented stable flap morphology and function. Two cases were died of the recurrent melanoma and general translation. Conclusions：Surgerical principles based on EBM strategies for heel melanoma are effective and efficient. Diverse flaps can be elevated from the medial plantar area to conveniently repair heel defects of various levels.