Evaluating Complications of Surgical Reconstructive Approaches for Plantar Melanoma: A Systematic Review and Meta-analysis.

Abstract: Reconstruction of plantar melanoma presents a surgical challenge due to unique qualities of plantar soft tissue and its role as a weight-bearing surface. Therefore, careful design and selection of coverage option are required to optimize functional recovery and limit postoperative complications on the plantar aspect of the foot. The purpose of this study was to perform a systematic review and meta-analysis on the difference in complication rates between 3 coverage options for the reconstruction of plantar melanoma defects: free flaps, pedicle flaps, and skin grafts. Ovid MEDLINE, EMBASE, and Cochrane CENTRAL were utilized to identify articles dating from 2000 to 2023. Nineteen studies met the inclusion criteria for qualitative analysis and 14 studies for quantitative analysis, which comprised retrospective and prospective studies. Seven studies within the quantitative analysis included free flaps, 6 included pedicle flaps, and 2 included skin grafts, totaling 159 reconstruction procedures. A comparative analysis using inverse variance method was applied to compare complication rates across coverage options. No significant difference was found for the incidence rate of at least 1 complication, the total number of complications, or total number of flap loss/total flap necrosis between free flaps, pedicle flaps, and skin graft procedures (all P > 0.05). No superior coverage option for plantar melanoma defects is evident based on pooled complication rates in this study; therefore, factors such as tumor size/depth, vascular status, and anatomic location in relation to weight-bearing status should be used to determine reconstructive choice.