The Clinical Outcome of Flap Coverage for the Treatment of Malignant Melanoma

In surgical treatment of the malignant melanoma, radical resection and a sentinel lymph node biopsy are essential procedures to eradicate the tumor and to minimize the risk of local recurrence. For the reconstruction of skin defect after tumor resection, a skin graft has been generally performed procedure. However, if tendon or bone is exposed after tumor resection, simple skin graft is not enough for the coverage of the defect and additional procedure is mandatory. In this study, we reviewed the clinical results of 16 patients, who had been diagnosed with malignant melanoma of the limb and underwent surgical resection and reconstruction of the defect with various methods. The sentinel lymph node dissection was performed in all patients combined with radical excision of the tumor. In 11 cases of positive sentinel lymph nodes, further elective lymph node dissections were performed. The mean tumor invasion depth was 4.54 mm (2~10 mm), and AJCC stage II was most common (9 cases). The pedicled flaps were performed in 10 cases for the reconstruction of defects. All flaps were successfully survived without significant complications until the last follow up. In conclusion, a pedicled flap coverage is very useful reconstruction strategy for the soft tissue defects after radical resection of malignant melanoma.

The Effect of Nitric Oxide Donor, SNAC on Motor Functional Recovery of Reperfused Peripheral Nerve / 대한정형외과학회잡지

PURPOSE: To investigate the effects of nitric oxide (NO) donor, S-nitroso-N-acetylcysteine (SNAC) on the motor functional recovery of a reperfused rat sciatic nerve. MATERIALS AND METHODS: Seventy-eight rats were divided into the following 3 groups: SNAC, methylprednisolone (MP), and phosphate buffered saline (PBS)-treated groups. A 1 cm segment of the sciatic nerve underwent 2 hours of ischemia followed by 90 minutes of reperfusion. The results were evaluated using a walking track test, muscle contractile test and an examination of the muscle weight and histology at various reperfusion periods. RESULTS: There was a significant improvement in the sciatic functional index (SFI) and contractile force of the SNAC-treated group compared with the MP and PBS groups. The SNAC group showed earlier improvement in the SFI measurement between days 7-28. The contractile force and muscle weight of the extensor digitorum longus muscle began to be restored earlier in the SNAC group after day 11, while the others showed progressive atrophy until day 21. The histology examination revealed less severe degeneration and earlier regeneration of axons in the SNAC-treated rats than the other groups. CONCLUSION: The supplementation of NO is effective in promoting the motor functional recovery of a reperfused peripheral nerve and has the potential to replace or augment steroids as a therapeutic agent in the treatment of nervous system ischemia/reperfusion injuries.