The results of various methods of defect replacement with local tissues in case of extensive excision of melanoma of the skin of the trunk and extremities

Introduction. Cutaneous melanoma is one of the most aggressive oncological neoplasms requiring radical surgical treatment with compulsory wide resection of the primary tumor. The problem of restoration of anatomical integrity and functionality of the tissues after tumor resection is very important for favorable prognosis and high quality of life of the patients. Efficacy of the current techniques of reconstruction using local tissues depends on the size and location of the defect.
Aim. To compare short-term results of different types of defect reconstruction using local tissues after wide resection of cutaneous melanoma of the trunk and limbs.
Materials and methods. Prospective analysis of radical surgical treatment of 62 patients with cutaneous melanoma of the trunk and limbs of localized stages (сT1–4N0M0, Eastern Cooperative Oncology Group (ECOG) score 0–1) who at the 1st stage of treatment underwent wide tumor resection with subsequent reconstruction using local tissues was performed. Median age was 61 years (±8.5 years). The study included 33 (53.2 %) women and 29 (46.8%) men. Radical surgical resection included wide melanoma resection aimed to prevent tumor cell dissemination and achieve negative resection margins. The reconstruction stage included 2 main approaches: defect reconstruction using local advancement flaps (38 (61.3 %) cases) and mobilization of the skin margins (24 (38.7 %) cases). Selection of plastic surgery technique depended on tumor location, defect size after its resection, and individual anatomical features of the patient. 
The surgeries were primarily performed on the trunk (30 (48.4 %) cases) and limbs (32 (51.6 %) cases). During surgical intervention, special attention was paid to preservation of cutaneous flap blood flow and minimization of trauma to the surrounding wound tissues.
Results. In the postoperative period, analysis of complications on days 3, 7, 14 and 30 after surgical intervention was performed. Overall complication rate was 16.1 % (n = 10). Adverse events after surgeries on the trunk were significantly rarer (2 (3.2 %) cases) than after surgeries on the limbs (8 (12.9 %) cases). In the local advancement flap group, complications were observed in 4 (10.5 %) cases, primarily in cases of tumors located on the limbs (3 (7.9 %) cases). For trunk location of the tumor, adverse events were observed in only 1 (2.6 %) patient. The main complications were clinically significant seroma, wound margin diastasis, and wound abscess. In the skin margin mobilization group, the incidence of adverse events was 2.5 times higher than in the local advancement flap group (6 (25 %) cases); they primarily occurred in cases of tumors located on the limbs (5 (20.8 %) cases). The most common complications were necrosis of the skin margins and wound abscess. Despite the development of adverse events, in the majority of cases (in more than 75 % of patients) standard time of wound healing (days 14–21) was achieved. Patients with complications received conservative treatment. This allowed to avoid serious consequences but increased healing time which could delay the start of necessary adjuvant drug therapy. These results demonstrate that in surgical treatment of cutaneous melanoma, the selection of defect reconstruction technique and surgical area significantly affects the rate of postoperative complications and their type.
Conclusion. In skin defect reconstruction using local advancement flaps after wide resection of cutaneous melanoma of the trunk and limbs, postoperative complications are 2.5 times rarer than in mobilization of skin margins, especially in cases of defect repair on the limbs. Selection of plastic surgery technique must be made individually taking into account tumor location and size of the defect after tumor resection.

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