Full-thickness skin graft after nail complex resection for malignant tumors Journal Article


Authors: Puhaindran, M. E.; Cordeiro, P. G.; Disa, J. J.; Mehrara, B. J.; Athanasian, E. A.
Article Title: Full-thickness skin graft after nail complex resection for malignant tumors
Abstract: Melanoma in situ and early squamous cell carcinoma can be treated successfully with excision with narrow margins. However, as the extent of disease is known only after pathologic examination of the entire lesion, the appropriate initial surgical margin is a dilemma. Lesions that involve the nail complex present an additional challenge for surgeons-whether to excise the nail complex partially or completely. The ideal form of reconstruction is also in question. We elect to completely excise the nail complex with immediate reconstruction using a full-thickness skin graft, allowing complete tumor clearance and preserving the distal phalanx. We retrospectively reviewed records of patients who had undergone complete nail complex excision and immediate skin grafting. We assessed the need for additional procedures for positive resection margins, full-thickness skin graft take on the bare bone of the distal phalanx, and final aesthetic appearance. Our study included 9 patients who had surgery on a total of 10 digits. One patient underwent repeat resection with distal phalanx disarticulation after pathologic assessment revealed a positive margin for an invasive tumor No patients had a local recurrence. Two patients required a second procedure-one for excision of a nail remnant and another for excision of an epidermal inclusion cyst. All patients were satisfied with the results, with none wanting further nail reconstruction, and all returned to presurgery use of the hand. This technique is effective for managing melanoma in situ and early squamous cell carcinoma that affect the nail complex. © 2011 Lippincott Williams & Wilkins, Inc.
Keywords: squamous cell carcinoma; full-thickness skin graft; melanoma in situ; nail complex
Journal Title: Techniques in Hand and Upper Extremity Surgery
Volume: 15
Issue: 2
ISSN: 1089-3393
Publisher: Lippincott Williams & Wilkins  
Date Published: 2011-06-01
Start Page: 84
End Page: 86
Language: English
DOI: 10.1097/BTH.0b013e3181ee7e00
PROVIDER: scopus
PUBMED: 21606778
DOI/URL:
Notes: --- - "Export Date: 3 October 2011" - "CODEN: THUEA" - "Source: Scopus"
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MSK Authors
  1. Joseph Disa
    214 Disa
  2. Babak Mehrara
    288 Mehrara
  3. Peter G Cordeiro
    254 Cordeiro