Summary
For the treatment of melanoma of thumb, the evidence about amputation level (IP joint
or MP joint) and cutaneous excision margin has not been fully presented. And reconstructions
for lost thumbs need to be balanced against functional and aesthetic requirements
of individual patients and overall prognosis. We report 15 patients, who underwent
primary excision and reconstruction for thumb melanoma between 1986 and 2004 at Department
of Plastic and Reconstructive Surgery, University of Hokkaido at Sapporo, Graduate
School of Medicine. The patients were reviewed to evaluate the prognostic significance
of variables including age and sex of the patient, tumour thickness, staging, level
of amputation, and cutaneous excision margin. Our 15 cases were divided into two groups
according to amputation level (MP or IP) and cutaneous excision margin (<40 mm or ≧40 mm) and prognosis was analysed statistically. The stage and thickness were identified
as prognostic factors for disease-free survival; however, IP amputation and 10–30 mm margin did not compromise disease-free survival. Amputated thumb was reconstructed
by pollicization, free toe to thumb transfer, reverse forearm flap, local flap, and
skin graft. No major complication of reconstructed thumb occurred. Seven of eight
cases of MP amputation were reconstructed by pollicization. On the other hand, five
cases of IP amputation were reconstructed by volar skin flap in two cases, reverse
forearm flap in two cases, and trimmed first toe transfer in one case. Although a
small number of cases, our study is the first attempt focussing on melanoma of thumb,
and evaluating amputation level and cutaneous margin separately. The reconstructive
algorithm for the amputated thumb is proposed and has various tools including free
toe to thumb transfer.
Keywords
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Article info
Publication history
Published online: June 06, 2006
Accepted:
January 28,
2006
Received:
December 19,
2005
Footnotes
☆This work was presented in ASPS 2005 in Chicago, 25 September 2005.
Identification
Copyright
© 2006 The British Association of Plastic Surgeons. Published by Elsevier Inc. All rights reserved.
