CASE REPORT


Two-phase Surgery Using a Dermal Regeneration Material for Nail Unit Melanoma: Three Case Reports



Shiro Iino1, *, Suguru Sato1, Natsuki Baba1, Naoki Maruta1, Wataru Takashima1, Noritaka Oyama1, Takahiro Kiyohara2, Masato Yasuda3, Minoru Hasegawa1
1 Department of Dermatology, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
2 Department of Dermatology, Kansai Medical University, Osaka, Japan
3 Department of Plastic Surgery, University of Saga, Saga, Japan


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© 2017 Iino et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Dermatology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui 910-1193, Japan; Tel: +81-776-61-8367; Fax: +81-776-61-8112; E-mail: shiro@u-fukui.ac.jp


Abstract

Background:

Nail unit melanoma (NUM) poses a considerable treatment challenge, particularly in cases with in situ or early invasive lesions, and wide excision with phalanx amputation. For post-excisional skin defects, stump plasty and/or split-thickness skin grafting may cause persisted irritation and ulceration as a post-operative complication, because of the insufficient underlying tissue volume, vascularity, and stability.

Objective:

To seek out other superior management avoiding disadvantages associated with the conventional NUM surgery.

Method:

Three consecutive cases with NUM were treated by a novel two-phase surgical procedure using a commercially available dermal regeneration template; as the first phase, the lesional nail unit was excised and subsequently covered by a dermal regeneration template onto the phalangeal bone surface, allowing development of robust granulation with extracellular matrix and vascular network. Thereafter, the second phase employed a full-thickness skin grafting.

Results:

All three cases accomplished complete removal of the NUM lesion, and achieved a good cosmetic and functional outcome, maintaining physiological firmness, contour, and less contraction and atrophy of the overlying skin. They did not complain of major post-operative complications.

Conclusion:

Our two-phase approach using a dermal regeneration material is a satisfactory and straightforward technique, achieving a substantial benefit functionally and cosmetically in the post-operative period. We propose that the additional use of a tissue regeneration material can provide superior results for the reconstruction step of excised NUM.

Keywords: Nail unit melanoma, Dermal regeneration template, Preserved subcutaneous, Vascular network, Skin grafting, Surgery.