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1</a>&#41;&#46; The excision was planned with 2-cm margins due to a previous punch biopsy of the most palpable area reporting a 2&#46;2-mm Breslow index&#46; The resultant full-thickness defect measured 8&#46;5&#8239;&#215;&#8239;10&#46;0&#8239;cm with exposure of the underlying tendons on the fifth phalanx and involved the fourth interdigital space &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; A sentinel lymph node biopsy was performed in the same procedure to assess nodal involvement&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">After a discussion of repair alternatives with patient&#44; the application of this dermal skin substitute was elected&#46; The matrix was cut to fit the size of the defect in two pieces&#58; one for the lateral and plantar surface&#44; and a small piece for the coverage of the fifth phalanx&#46; The collagenous inner layer of both pieces was placed in contact with the wound bed and secured with a 3&#47;0 Nylon suture &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The authors prefer to use sutures rather than surgical staples in weight-bearing areas&#44; as the latter may cause occasional pain if pressure is applied unconsciously&#46; A few vertical incisions were performed on the protective silicone layer to facilitate the drainage of post-operative exudation or hematoma&#46; The surgical area was covered with a non-adherent silicone dressing&#44; gauze and low compression bandage up to the knee&#46; The patient was instructed to avoid local pressure in the following weeks&#46; Follow-up visits were performed every week&#44; dressings were replaced in each visit&#44; and the matrix was constantly examined for signs of infection&#44; air bubbles or hematoma&#46; The early identification of the latter in the first postoperative days is critical for adequate engraftment&#44; and they can be easily drained with a sterile needle puncture&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Three weeks after the initial procedure&#44; the graft revealed a characteristic yellow-orange tone through the silicone layer that indicated good engraftment &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>A&#41;&#46; The temporary silicone layer was easily removed in the operating room and a split-thickness graft was obtained from the ipsilateral thigh to provide permanent epidermal coverage &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>B&#41;&#46; Afterward&#44; the wound dressings were replaced on a weekly basis until complete healing&#46; At 6-months of follow-up&#44; the graft has provided full coverage of the defect with a satisfactory functional and aesthetic outcome &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46; Mild hyperpigmentation is noticeable compared to the surrounding skin although no scar retraction is observed&#46; The patient does not present any walking disability or pain related to ambulation&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">The aim of a surgical repair in acral surfaces is to fully replace the lost volume and optimize tissue match &#40;both color and texture&#41; while maintaining functionality without any relevant sequel&#46; A sufficient soft-tissue volume is required in weight-bearing areas to cover the underlying bone and allow proper ambulation&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Surgical alternatives regularly employed in this location are split or full-thickness skin grafting&#44; secondary intention healing with or without negative pressure&#44; application of skin substitutes&#44; local flaps&#44; and microvascular techniques&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;8</span></a> The individualized decision of which procedure or product to use depends on patients&#8217; specifics such as wound size&#44; age&#44; comorbidities&#44; social&#44; psychological&#44; and economic factors&#46; Postoperative complications may include hematoma&#44; wound infection&#44; thromboembolism&#44; flap loss&#44; and in exceptional cases&#44; progression to amputation&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Secondary intention healing causes a prolonged disability and may lead to tissue necrosis&#44; scar contraction&#44; or contour abnormalities&#46; Full-thickness skin grafts provide adequate coverage&#44; although an exceptionally large donor site is required in defects larger than 5&#8239;cm that may not always be available&#46; The authors&#8217; experience with skin grafts in this location is disappointing because graft loss in weight-bearing areas is quite common&#46; Local and pedicle flaps may be difficult to perform due to the difficulty of finding an adequate tissue reservoir&#46; Microvascular techniques seem a reasonable option in young patients&#44; although they are time-consuming&#44; not available in all settings&#44; and mostly require general anesthesia&#46; Lastly&#44; partial amputation should be avoided in young patients whenever possible&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In the last decades&#44; a wide variety of dermal substitutes have been developed&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> Depending on the architecture of the substitute&#44; they can be classified in acellular and cellular dermal matrices&#46; Acellular dermal matrices provide materials similar to the host extracellular matrix&#44; induce dermal regeneration&#44; angiogenesis&#44; and prevent fluid loss and contamination in the early stages of tissue repair&#46; Compared to cellular dermal matrices&#44; they are cheaper and easier to store&#46; Both are useful in deep wounds or those with bone&#44; tendon&#44; or cartilage exposure as they provide considerable soft-tissue volume&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Integra&#174; Bilayer Wound Matrix &#40;Integra Lifesciences&#44; Plainsboro&#44; NJ&#41; is a bovine acellular dermal xenograft that presents an outer silicone layer and an inner layer &#40;&#8220;neo-dermis&#8221;&#41; composed of cross-linked bovine tendon collagen and shark-derived chondroitin-6-sulfate&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Other similar acellular dermal substitutes like Nevelia&#174; Bilayer Matrix lack glycosaminoglycans in its &#8220;neo-dermis&#8221; but present a polyester-reinforced silicon layer that provides better protection&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The outer silicone layer provides temporary protection while the permanent inner layer promotes dermal regeneration through a period of three to four weeks&#46; Afterward&#44; a second surgical procedure is required to remove the outer silicone layer and cover the &#8220;neo-dermis&#8221; by a definitive split-thickness graft&#46; Both surgical interventions can be performed in an ambulatory setting&#44; as opposed to other complex alternatives in this location that may require general anesthesia&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In conclusion&#44; large defects on the plantar surface secondary to acral melanoma excision may become a reconstructive challenge&#44; especially in young patients&#46; While secondary healing intention may show acceptable results&#44; the prolonged disability caused by pain and wound care is a disadvantage&#46; Acellular dermal matrices represent an easy alternative to cover deep wounds or those with bone or tendon exposure&#46; Despite their high cost and the requirement of two surgical procedures&#44; this surgical alternative may offer excellent functional and aesthetic results&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial support</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Author&#8217;s contributions</span><p id="par0060" class="elsevierStylePara elsevierViewall">Enrique Rodr&#237;guez-Lomba&#58; Approval of the final version of the manuscript&#59; critical literature review&#59; data collection&#44; analysis&#44; and interpretation&#59; effective participation in research orientation&#59; intellectual participation in propaedeutic and&#47;or therapeutic management of studied cases&#59; manuscript critical review&#59; preparation and writing of the manuscript&#59; study conception and planning&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Bel&#233;n Lozano-Masdemont&#58; Approval of the final version of the manuscript&#59; effective participation in research orientation&#59; intellectual participation in propaedeutic and&#47;or therapeutic management of studied cases&#59; manuscript critical review&#59; preparation and writing of the manuscript&#59; study conception and planning&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Alejandro S&#225;nchez-Herrero&#58; Approval of the final version of the manuscript&#59; effective participation in research orientation&#59; intellectual participation in propaedeutic and&#47;or therapeutic management of studied cases&#59; manuscript critical review&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Jose Antonio Avil&#233;s-Izquierdo&#58; Approval of the final version of the manuscript&#59; critical literature review&#59; intellectual participation in propaedeutic and&#47;or therapeutic management of studied cases&#59; manuscript critical review&#59; preparation and writing of the manuscript&#59; study conception and planning&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Large defects in plantar surface secondary to acral melanoma excision can be difficult to repair with local flaps&#44; and skin grafts in weight-bearing surfaces often suffer necrosis causing prolonged disability&#46; Acellular dermal matrices represent an easy alternative to cover deep wounds or those with bone or tendon exposure&#46; Despite their high cost and the requirement of two surgical procedures&#44; this alternative may offer excellent functional and aesthetic results in acral defects&#46;</p></span>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A bi-layer matrix wound dressing is used to cover both the plantar defect and the fifth proximal phalanx&#46; A few small vertical incisions are made over the outer layer of the matrix to facilitate drainage of exudate or hematoma&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Three weeks after matrix placement&#46; &#40;A&#41;&#44; The matrix reveals an orange tone through the outer silicone layer&#46; &#40;B&#41;&#44; The outer silicone layer is easily removed and the &#8220;neo-dermis&#8221; is temporarily exposed and covered by a split-thickness graft&#46;</p>"
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      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acral melanoma&#58; considerations about the surgical management of this tumor"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46;M&#46; Zyman"
                            1 => "J&#46;A&#46;J&#46;D&#46; Cunha"
                            2 => "A&#46;O&#46; Gimenez"
                            3 => "M&#46; Maia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.abd.2019.09.019"
                      "Revista" => array:7 [
                        "tituloSerie" => "An Bras Dermatol"
                        "fecha" => "2019"
                        "volumen" => "94"
                        "paginaInicial" => "632"
                        "paginaFinal" => "633"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31777374"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1198743X15003778"
                          "estado" => "S300"
                          "issn" => "1198743X"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical excision margin for primary acral melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K&#46;T&#46; Lee"
                            1 => "E&#46;J&#46; Kim"
                            2 => "D&#46;Y&#46; Lee"
                            3 => "J&#46;H&#46; Kim"
                            4 => "K&#46;T&#46; Jang"
                            5 => "G&#46;H&#46; Mun"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/jso.24442"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Surg Oncol"
                        "fecha" => "2016"
                        "volumen" => "114"
                        "paginaInicial" => "933"
                        "paginaFinal" => "939"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27642170"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acral lentiginous melanoma of the toe treated using Mohs surgery with sparing of the digit and subsequent reconstruction using split-thickness skin graft"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;P&#46; Loosemore"
                            1 => "A&#46; Morales-Burgos"
                            2 => "L&#46;H&#46; Goldberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2012.02569.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "2013"
                        "volumen" => "39"
                        "paginaInicial" => "136"
                        "paginaFinal" => "138"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22931051"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of secondary intention healing and full-thickness skin graft after excision of acral lentiginous melanoma on foot"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;Y&#46; Jung"
                            1 => "H&#46;J&#46; Roh"
                            2 => "S&#46;H&#46; Lee"
                            3 => "K&#46; Nam"
                            4 => "K&#46;Y&#46; Chung"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2011.02043.x"
                      "Revista" => array:7 [
                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "2011"
                        "volumen" => "37"
                        "paginaInicial" => "1245"
                        "paginaFinal" => "1251"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21615605"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0213005X13701381"
                          "estado" => "S300"
                          "issn" => "0213005X"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reconstruction of large wounds using a combination of negative pressure wound therapy and punch grafting after excision of acral lentiginous melanoma on the foot"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Seo"
                            1 => "J&#46; Kim"
                            2 => "K&#46;A&#46; Nam"
                            3 => "Z&#46; Zheng"
                            4 => "B&#46;H&#46; Oh"
                            5 => "K&#46;Y&#46; Chung"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/1346-8138.13017"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Dermatol"
                        "fecha" => "2016"
                        "volumen" => "43"
                        "paginaInicial" => "79"
                        "paginaFinal" => "84"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26173565"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of negative pressure wound therapy and secondary intention healing after excision of acral lentiginous melanoma on the foot"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "B&#46;H&#46; Oh"
                            1 => "S&#46;H&#46; Lee"
                            2 => "K&#46;A&#46; Nam"
                            3 => "H&#46;B&#46; Lee"
                            4 => "K&#46;Y&#46; Chung"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/bjd.12099"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2013"
                        "volumen" => "168"
                        "paginaInicial" => "333"
                        "paginaFinal" => "338"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23362968"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Skin subtitutes&#58; an overview of the key players in wound management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Nathoo"
                            1 => "N&#46; Howe"
                            2 => "G&#46; Cohen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Aesthet Dermatol"
                        "fecha" => "2014"
                        "volumen" => "7"
                        "paginaInicial" => "44"
                        "paginaFinal" => "48"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25371771"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Foot reconstruction using free microvascular muscle flaps with skin grafts"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;W&#46; May Jr&#46;"
                            1 => "R&#46;J&#46; Rohrich"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Plast Surg"
                        "fecha" => "1986"
                        "volumen" => "13"
                        "paginaInicial" => "681"
                        "paginaFinal" => "689"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3533377"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical dressings and novel skin substitutes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46; Axibal"
                            1 => "M&#46; Brown"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.det.2019.03.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Clin"
                        "fecha" => "2019"
                        "volumen" => "37"
                        "paginaInicial" => "349"
                        "paginaFinal" => "366"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31084729"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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Case Report
Dermal substitutes: an alternative for the reconstruction of large full-thickness defects in the plantar surface
Enrique Rodríguez-Lombaa,
Corresponding author
enriquerlomba@outlook.com

Corresponding author.
, Belén Lozano-Masdemontb, Alejandro Sánchez-Herreroa, Jose Antonio Avilés-Izquierdoa
a Department of Dermatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
b Department of Dermatology, Hospital Universitario de Móstoles, Madrid, Spain
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1</a>&#41;&#46; The excision was planned with 2-cm margins due to a previous punch biopsy of the most palpable area reporting a 2&#46;2-mm Breslow index&#46; The resultant full-thickness defect measured 8&#46;5&#8239;&#215;&#8239;10&#46;0&#8239;cm with exposure of the underlying tendons on the fifth phalanx and involved the fourth interdigital space &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; A sentinel lymph node biopsy was performed in the same procedure to assess nodal involvement&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">After a discussion of repair alternatives with patient&#44; the application of this dermal skin substitute was elected&#46; The matrix was cut to fit the size of the defect in two pieces&#58; one for the lateral and plantar surface&#44; and a small piece for the coverage of the fifth phalanx&#46; The collagenous inner layer of both pieces was placed in contact with the wound bed and secured with a 3&#47;0 Nylon suture &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The authors prefer to use sutures rather than surgical staples in weight-bearing areas&#44; as the latter may cause occasional pain if pressure is applied unconsciously&#46; A few vertical incisions were performed on the protective silicone layer to facilitate the drainage of post-operative exudation or hematoma&#46; The surgical area was covered with a non-adherent silicone dressing&#44; gauze and low compression bandage up to the knee&#46; The patient was instructed to avoid local pressure in the following weeks&#46; Follow-up visits were performed every week&#44; dressings were replaced in each visit&#44; and the matrix was constantly examined for signs of infection&#44; air bubbles or hematoma&#46; The early identification of the latter in the first postoperative days is critical for adequate engraftment&#44; and they can be easily drained with a sterile needle puncture&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Three weeks after the initial procedure&#44; the graft revealed a characteristic yellow-orange tone through the silicone layer that indicated good engraftment &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>A&#41;&#46; The temporary silicone layer was easily removed in the operating room and a split-thickness graft was obtained from the ipsilateral thigh to provide permanent epidermal coverage &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>B&#41;&#46; Afterward&#44; the wound dressings were replaced on a weekly basis until complete healing&#46; At 6-months of follow-up&#44; the graft has provided full coverage of the defect with a satisfactory functional and aesthetic outcome &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46; Mild hyperpigmentation is noticeable compared to the surrounding skin although no scar retraction is observed&#46; The patient does not present any walking disability or pain related to ambulation&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">The aim of a surgical repair in acral surfaces is to fully replace the lost volume and optimize tissue match &#40;both color and texture&#41; while maintaining functionality without any relevant sequel&#46; A sufficient soft-tissue volume is required in weight-bearing areas to cover the underlying bone and allow proper ambulation&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Surgical alternatives regularly employed in this location are split or full-thickness skin grafting&#44; secondary intention healing with or without negative pressure&#44; application of skin substitutes&#44; local flaps&#44; and microvascular techniques&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;8</span></a> The individualized decision of which procedure or product to use depends on patients&#8217; specifics such as wound size&#44; age&#44; comorbidities&#44; social&#44; psychological&#44; and economic factors&#46; Postoperative complications may include hematoma&#44; wound infection&#44; thromboembolism&#44; flap loss&#44; and in exceptional cases&#44; progression to amputation&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Secondary intention healing causes a prolonged disability and may lead to tissue necrosis&#44; scar contraction&#44; or contour abnormalities&#46; Full-thickness skin grafts provide adequate coverage&#44; although an exceptionally large donor site is required in defects larger than 5&#8239;cm that may not always be available&#46; The authors&#8217; experience with skin grafts in this location is disappointing because graft loss in weight-bearing areas is quite common&#46; Local and pedicle flaps may be difficult to perform due to the difficulty of finding an adequate tissue reservoir&#46; Microvascular techniques seem a reasonable option in young patients&#44; although they are time-consuming&#44; not available in all settings&#44; and mostly require general anesthesia&#46; Lastly&#44; partial amputation should be avoided in young patients whenever possible&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In the last decades&#44; a wide variety of dermal substitutes have been developed&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> Depending on the architecture of the substitute&#44; they can be classified in acellular and cellular dermal matrices&#46; Acellular dermal matrices provide materials similar to the host extracellular matrix&#44; induce dermal regeneration&#44; angiogenesis&#44; and prevent fluid loss and contamination in the early stages of tissue repair&#46; Compared to cellular dermal matrices&#44; they are cheaper and easier to store&#46; Both are useful in deep wounds or those with bone&#44; tendon&#44; or cartilage exposure as they provide considerable soft-tissue volume&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Integra&#174; Bilayer Wound Matrix &#40;Integra Lifesciences&#44; Plainsboro&#44; NJ&#41; is a bovine acellular dermal xenograft that presents an outer silicone layer and an inner layer &#40;&#8220;neo-dermis&#8221;&#41; composed of cross-linked bovine tendon collagen and shark-derived chondroitin-6-sulfate&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Other similar acellular dermal substitutes like Nevelia&#174; Bilayer Matrix lack glycosaminoglycans in its &#8220;neo-dermis&#8221; but present a polyester-reinforced silicon layer that provides better protection&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The outer silicone layer provides temporary protection while the permanent inner layer promotes dermal regeneration through a period of three to four weeks&#46; Afterward&#44; a second surgical procedure is required to remove the outer silicone layer and cover the &#8220;neo-dermis&#8221; by a definitive split-thickness graft&#46; Both surgical interventions can be performed in an ambulatory setting&#44; as opposed to other complex alternatives in this location that may require general anesthesia&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In conclusion&#44; large defects on the plantar surface secondary to acral melanoma excision may become a reconstructive challenge&#44; especially in young patients&#46; While secondary healing intention may show acceptable results&#44; the prolonged disability caused by pain and wound care is a disadvantage&#46; Acellular dermal matrices represent an easy alternative to cover deep wounds or those with bone or tendon exposure&#46; Despite their high cost and the requirement of two surgical procedures&#44; this surgical alternative may offer excellent functional and aesthetic results&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial support</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Author&#8217;s contributions</span><p id="par0060" class="elsevierStylePara elsevierViewall">Enrique Rodr&#237;guez-Lomba&#58; Approval of the final version of the manuscript&#59; critical literature review&#59; data collection&#44; analysis&#44; and interpretation&#59; effective participation in research orientation&#59; intellectual participation in propaedeutic and&#47;or therapeutic management of studied cases&#59; manuscript critical review&#59; preparation and writing of the manuscript&#59; study conception and planning&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Bel&#233;n Lozano-Masdemont&#58; Approval of the final version of the manuscript&#59; effective participation in research orientation&#59; intellectual participation in propaedeutic and&#47;or therapeutic management of studied cases&#59; manuscript critical review&#59; preparation and writing of the manuscript&#59; study conception and planning&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Alejandro S&#225;nchez-Herrero&#58; Approval of the final version of the manuscript&#59; effective participation in research orientation&#59; intellectual participation in propaedeutic and&#47;or therapeutic management of studied cases&#59; manuscript critical review&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Jose Antonio Avil&#233;s-Izquierdo&#58; Approval of the final version of the manuscript&#59; critical literature review&#59; intellectual participation in propaedeutic and&#47;or therapeutic management of studied cases&#59; manuscript critical review&#59; preparation and writing of the manuscript&#59; study conception and planning&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Large defects in plantar surface secondary to acral melanoma excision can be difficult to repair with local flaps&#44; and skin grafts in weight-bearing surfaces often suffer necrosis causing prolonged disability&#46; Acellular dermal matrices represent an easy alternative to cover deep wounds or those with bone or tendon exposure&#46; Despite their high cost and the requirement of two surgical procedures&#44; this alternative may offer excellent functional and aesthetic results in acral defects&#46;</p></span>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A bi-layer matrix wound dressing is used to cover both the plantar defect and the fifth proximal phalanx&#46; A few small vertical incisions are made over the outer layer of the matrix to facilitate drainage of exudate or hematoma&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Three weeks after matrix placement&#46; &#40;A&#41;&#44; The matrix reveals an orange tone through the outer silicone layer&#46; &#40;B&#41;&#44; The outer silicone layer is easily removed and the &#8220;neo-dermis&#8221; is temporarily exposed and covered by a split-thickness graft&#46;</p>"
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      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acral melanoma&#58; considerations about the surgical management of this tumor"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46;M&#46; Zyman"
                            1 => "J&#46;A&#46;J&#46;D&#46; Cunha"
                            2 => "A&#46;O&#46; Gimenez"
                            3 => "M&#46; Maia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.abd.2019.09.019"
                      "Revista" => array:7 [
                        "tituloSerie" => "An Bras Dermatol"
                        "fecha" => "2019"
                        "volumen" => "94"
                        "paginaInicial" => "632"
                        "paginaFinal" => "633"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31777374"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1198743X15003778"
                          "estado" => "S300"
                          "issn" => "1198743X"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical excision margin for primary acral melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K&#46;T&#46; Lee"
                            1 => "E&#46;J&#46; Kim"
                            2 => "D&#46;Y&#46; Lee"
                            3 => "J&#46;H&#46; Kim"
                            4 => "K&#46;T&#46; Jang"
                            5 => "G&#46;H&#46; Mun"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/jso.24442"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Surg Oncol"
                        "fecha" => "2016"
                        "volumen" => "114"
                        "paginaInicial" => "933"
                        "paginaFinal" => "939"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27642170"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acral lentiginous melanoma of the toe treated using Mohs surgery with sparing of the digit and subsequent reconstruction using split-thickness skin graft"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;P&#46; Loosemore"
                            1 => "A&#46; Morales-Burgos"
                            2 => "L&#46;H&#46; Goldberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2012.02569.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "2013"
                        "volumen" => "39"
                        "paginaInicial" => "136"
                        "paginaFinal" => "138"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22931051"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of secondary intention healing and full-thickness skin graft after excision of acral lentiginous melanoma on foot"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;Y&#46; Jung"
                            1 => "H&#46;J&#46; Roh"
                            2 => "S&#46;H&#46; Lee"
                            3 => "K&#46; Nam"
                            4 => "K&#46;Y&#46; Chung"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2011.02043.x"
                      "Revista" => array:7 [
                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "2011"
                        "volumen" => "37"
                        "paginaInicial" => "1245"
                        "paginaFinal" => "1251"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21615605"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0213005X13701381"
                          "estado" => "S300"
                          "issn" => "0213005X"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reconstruction of large wounds using a combination of negative pressure wound therapy and punch grafting after excision of acral lentiginous melanoma on the foot"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Seo"
                            1 => "J&#46; Kim"
                            2 => "K&#46;A&#46; Nam"
                            3 => "Z&#46; Zheng"
                            4 => "B&#46;H&#46; Oh"
                            5 => "K&#46;Y&#46; Chung"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/1346-8138.13017"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Dermatol"
                        "fecha" => "2016"
                        "volumen" => "43"
                        "paginaInicial" => "79"
                        "paginaFinal" => "84"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26173565"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of negative pressure wound therapy and secondary intention healing after excision of acral lentiginous melanoma on the foot"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "B&#46;H&#46; Oh"
                            1 => "S&#46;H&#46; Lee"
                            2 => "K&#46;A&#46; Nam"
                            3 => "H&#46;B&#46; Lee"
                            4 => "K&#46;Y&#46; Chung"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/bjd.12099"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2013"
                        "volumen" => "168"
                        "paginaInicial" => "333"
                        "paginaFinal" => "338"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23362968"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Skin subtitutes&#58; an overview of the key players in wound management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Nathoo"
                            1 => "N&#46; Howe"
                            2 => "G&#46; Cohen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Aesthet Dermatol"
                        "fecha" => "2014"
                        "volumen" => "7"
                        "paginaInicial" => "44"
                        "paginaFinal" => "48"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25371771"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
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Article information
ISSN: 03650596
Original language: English
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