medigraphic.com

2024, Number 1

<< Back Next >>

rev homeostasis 2024; 6 (1)

Colgajo romboidal: alternativa reconstructiva del melanoma de bajo riesgo

Medina EN, López FD, Rendón MMA, Rendón MMA

Language: Spanish
References: 16
Page:
PDF size: 200.58 Kb.


ABSTRACT

Melanoma is an aggressive neoplasm in dermatology. Early detection and risk classification are crucial in its diagnostic evaluation for treatment. The Rhombic flap (Limberg) is a transposition and random pattern flap with opponent obtuse angles and straight angles useful in cutaneous defects. The aim is the description of this therapeutic tool in selected cases. A 43-year-old presented with an oval, brown, heterogeneous, hyperpigmented neoformation of 2 x 1.5 cm in posterior thorax with progressive growth and pruritus of 1 year of evolution. Melanoma was suspected. An ultrasound for lymph node detection was negative and an incision biopsy reported a low-risk superficial spreading melanoma with Breslow thickness of 0.7mm. It was treated with wide resection up to the fascia with negative margins (1cm) reported in histopathology. Closing of the secondary defect was done with a transposition of Rhombic flap (Limberg) without complications and any clinical recurrences in 1-year postoperative follow-up. Performing an adequate severity diagnosis and classification are keystones to achieve opportune prevention and treatment in melanoma. In conclusion the rhombic flap is a useful and safe complementary therapeutic tool in secondary defects resulting from low-risk melanoma in dermatologic surgery.


REFERENCES

  1. García-Rementería, C. Melanoma. EnArenas-Guzmán R., Dermatología. Atlas,diagnóstico y tratamiento. McGraw-Hill, 2019;830-841.

  2. Cámara-Salazar, A, Santos-Zaldívar, KP,Bracamonte-Barahona, R, Calderón-Sauri I.S. &col. Características individuales y por entidadfederativa de la mortalidad por melanoma enMéxico entre 2014 y 2018. Dermatol Rev Mex2020 mayo-junio;64(3):248-254.

  3. Dzwierzynski WW. Melanoma Risk Factors andPrevention. Clin Plast Surg. 2021Oct;48(4):543-550.doi: 10.1016/j.cps.2021.05.001.

  4. Guía de Práctica Clínica (GPC). Abordajediagnóstico de melanoma maligno. México:Instituto Mexicano del Seguro Social, 2010.Recuperado de:https://www.imss.gob.mx/sites/all/statics/guiasclinicas/547GER.pdf

  5. Gershenwald, J.E., Scolyer, R.A. MelanomaStaging: American Joint Committee on Cancer(AJCC) 8th Edition and Beyond. Ann Surg Oncol25, 2105–2110 (2018).https://doi.org/10.1245/s10434-018-6513-7

  6. Swetter SM, Thompson JA, Albertini MR, BarkerCA et al. NCCN Guidelines Insights: Melanoma:Cutaneous, Version 2.2021. J Natl Compr CancNetw. 2021 Apr 1;19(4):364-376.doi: 10.6004/jnccn.2021.0018.

  7. Swetter SM, Tsao H, Bichakjian CK,Curiel-Lewandrowski C et al. Guidelines of carefor the management of primary cutaneousmelanoma. J Am Acad Dermatol. 2019Jan;80(1):208-250.doi: 10.1016/j.jaad.2018.08.055.

  8. Ho W, Jones CD. Geometry and design of arhomboid flap. J Plast Surg Hand Surg. 2021Aug;55(4):249-254.doi: 10.1080/2000656X.2021.1873792.

  9. Garbe C, Amaral T, Peris K, Hauschild A et al.European consensus-based interdisciplinaryguideline for melanoma. Part 2: Treatment -Update 2022. Eur J Cancer 2022Jul;170:256-284.doi: 10.1016/j.ejca.2022.04.018.

  10. Miller CJ. Design principles for transpositionflaps: the rhombic (single-lobed), bilobed, andtrilobed flaps. Dermatol Surg. 2014 Sep;40Suppl 9:S43-52. doi:10.1097/DSS.0000000000000115.

  11. Medina-Murillo GR, Rodríguez-Medina U,Rodriguez-Wong U. Colgajo de Limberg : suutilidad en dermatología cosmética. Rev HospJua Mex 2015 ; 82(2) : 118-21.

  12. Bello DM, Faries MB. The Landmark Series:MSLT-1, MSLT-2 and DeCOG (Management ofLymph Nodes). Ann Surg Oncol. 2020Jan;27(1):15-21.doi: 10.1245/s10434-019-07830-w.

  13. Taleb M, Choi L, Kim S Safety and efficacy of thekeystone and rhomboid flaps for immediatereconstruction after wide local excision ofnon-head and neck melanomas. World J SurgOncol 2016 Oct 19;14(1):269.doi: 10.1186/s12957-016-1019-x.

  14. Johnson KS, Blattner CM, Lear W. Simplifiedapproach to the design of rhombic flaps. J AmAcad Dermatol. 2019 Jul;81(1):e7-e8.doi: 10.1016/j.jaad.2018.08.027.

  15. Johnson TM, Wang TS, DJ Fader. The birhombictransposition flap for soft tissue reconstruction. JAm Acad Dermatol. 1999 Aug;41(2 Pt 1):232-6.doi: 10.1016/s0190-9622(99)70054-x.

  16. Rohrer TE, Bhatia A. Transposition flaps incutaneous surgery. Dermatol Surg. 2005Aug;31(8 Pt 2):1014-23.doi: 10.1111/j.1524-4725.2005.31826.




2020     |     www.medigraphic.com