Open Access
CC BY 4.0 · Arch Plast Surg 2025; 52(02): 090-095
DOI: 10.1055/s-0044-1792109
Hand/Peripheral Nerve
Case Report

Serratus Anterior Fascia Free Flap for Functional Surgery of Subungual Melanoma: Case Series and Literature Review

Soo Jin Woo 
1   Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
,
Sung Tack Kwon 
1   Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
,
Byung Jun Kim 
1   Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
› Author Affiliations
Funding None.
› Further Information
  Permissions and Reprints
Preview

Abstract

Background In addressing subungual melanoma, this study presents the efficacy of wide excision followed by reconstruction using a serratus anterior fascial free flap.

Methods The study covers four patients treated between 2017 and 2020 for melanoma in the great toe or thumb, highlighting the successful application of the flap and split-thickness skin graft over exposed distal phalanx cortical bone.

Results The Breslow depths of the melanomas ranged from 0.2 to 6 mm, with four to seven lymph nodes dissected per patient, revealing no metastasis. Over follow-ups of 26 to 57 months, no local or distant recurrences were observed. The serratus anterior fascial free flaps, averaging 2.1 mm in thickness, precisely matched defect depths, negating the need for further debulking.

Conclusion This technique offered satisfactory functional and aesthetic outcomes, proposing the serratus anterior fascial free flap as a viable alternative for acral region reconstruction in subungual melanoma cases after wide excision.

Keywords

subungual melanoma - serratus anterior fascia free flap - nail unit - fingertip - microsurgery

Authors' Contributions

Conceptualization was done by B.J.K. Data curation and formal analysis were done by S.J.W. The methodology was developed by B.J.K. and S.T.K. The original draft was written by S.J.W. All the authors were involved with writing, reviewing, and editing of the manuscript.


Ethical Approval

The studywas approved by the Institutional ReviewBoard (H-2106-208-1231).


Patient Consent

Informed consent was obtained from all participants.




Publication History

Received: 14 February 2024

Accepted: 09 October 2024

Article published online:
11 March 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA