The role of soft tissue reconstruction after melanoma resection in the head and neck

Introduction. Reconstruction after wide local excision of melanomas in the head and neck can be formidable. Many tumors lie close to vital structures. and excision must carefully balance preservation of form and function. For small defects, primary closure or skin grafting is satisfactory. However, it has become increasingly evident that more advanced reconstructive proced ures can improve the outcome in terms of both function and aesthetics. This study was undertaken to determine the effectiveness of flap closure after wide local excision of melanomas in the head and neck and to develop a set of surgical recommendations on the basis of our experience. Method. We reviewed 35 patients who underwent 39 flap closures at The Unive rsity of Texas, M. D. Anderson Cancer Center after wide local excision of h ead and neck melanomas. Local flaps were primarily used to close defects af ter the resection of superficial or intermediate-thickness melanomas. Pedic le and free flaps were used to cover larger defects resulting from the exci sion of extensive tumors. The flap closures were compared with an analogous database of 560 melanoma resections that underwent primary closure or skin grafting. Results. The mean age of the patient population was 57 years. The most comm on location for tumor presentation was the cheek, followed by the ear, fore head. and lip. Pathologic findings most commonly demonstrated superficial s preading melanoma, and the average defect size was 30.7 cm(2). Local flaps were used most often for reconstruction. The only variable that significant ly predicted local recurrence was the depth of the tumor. Local. pedicle, o r free flaps did not decrease the ability of detecting local recurrence or increase this number compared with primary closure and skin grafting. Major postoperative complications were detected in seven patients. We found flap closure to achieve excellent functional and aesthetic results. Conclusion. Although primary closure is the ideal method of reconstruction for small defects, flap closure provides a versatile and safe alternative w hen simple closure would yield unsatisfactory results. With careful plannin g, flap closure offers an exceptional functional and aesthetic result and m ay even enhance contour defects after extensive neck or parotid dissections . Moreover, our experience with flap closure did not appear to delay the de tection of local recurrence and may have even served to decrease the incide nce of local failure after wide local excision of head and neck melanomas. (C) 2000 John Wiley & Sons, Inc.