Foot Melanoma Reconstruction Using Refined Perforator Flap: Safety, Function, and Subregional Surgical Strategy.

Abstract

Reconstruction of foot melanoma defects requires not only durable resurfacing and minimal functional impairment but also region-specific surgical planning. This study evaluates the outcomes of reconstruction using refined thin perforator flaps and analyzes subregional surgical details to propose tailored strategies. Patients with foot melanoma who underwent wide excision and immediate reconstruction using free perforator flaps with appropriately tailored thickness between 2005 and 2023 were reviewed. Outcomes included postoperative complications, the need for secondary debulking, and functional outcomes assessed using the Foot Function Index (FFI). Reconstructive techniques were analyzed by anatomical subregion. In total, 226 patients were analyzed. The most common site was the weight-bearing heel. The thoracodorsal artery perforator flap was most frequently used, followed by the anterolateral thigh flap. Overall complications occurred in 43 cases (19.0%), with delayed healing being the most common. Flap failure occurred in 5 cases. Recipient vessel selection was significantly associated with both overall and perfusion-related complications. Site-specific patterns were noted in the combinations of flap type and recipient vessel. Secondary debulking was performed in 34 patients (15%) and was significantly associated with toe defects, female, and larger defect size, but not with flap type. FFI scores, available for 70 patients, averaged 7.9 and showed no significant difference compared to other reconstruction methods. Free perforator flaps appear to provide reliable reconstruction for foot melanoma defects, with low rates of complications and secondary debulking, as well as favorable functional outcomes. Region-specific strategies for flap and recipient vessel selection may further optimize outcomes.