Limb-sparing reconstruction of acral lentiginous melanoma on the plantar foot using biodegradable temporizing matrix and split-thickness skin grafting: a case report

TL;DR

A new surgical technique using biodegradable materials and skin grafts successfully treated a rare foot melanoma without amputation.

Contribution

A limb-sparing reconstructive approach using biodegradable temporizing matrix and split-thickness skin grafting is proposed for plantar acral lentiginous melanoma.

Findings

The patient regained full foot function after reconstruction without donor site morbidity.

The technique enabled early ambulation and low complication rates in an elderly patient.

Biodegradable temporizing matrix with skin grafting offers an effective alternative to flap reconstruction.

Abstract

Acral lentiginous melanoma, a rare and aggressive melanoma subtype, often affects weight-bearing areas like the sole of foot, presenting complex reconstructive challenges after wide local excision. An 87-year-old female chiropodist with a 4.5-cm, 1-mm thick ALM on her left ball of foot underwent wide local excision with 1-cm margins, preserving hallux neurovascular bundles and achieving complete excision. Reconstruction utilized a biodegradable temporizing matrix (BTM) with negative pressure wound therapy for 5 weeks, followed by split-thickness skin grafting (SSG) after BTM delamination. She remained non-weight-bearing during recovery and regained full foot function long-term. BTM with SSG facilitates robust neodermis formation, offering an effective alternative to flap reconstruction, especially in elderly patients or defects with exposed bone or tendon, avoiding donor site morbidity while ensuring favorable functional outcomes with early ambulation and low complication rates. This approach highlights a shift toward limb-sparing techniques over amputation for plantar ALM in appropriately selected patients.

Figures