LAUSR

Dear Editor, The crossed digital flap is a reconstructive technique indicated for surgical defects of the fingers, as it is an interpolated flap carried from an adjacent finger. It was described by Gurdin and Pangman in 1950 to reconstruct digital defects of the hands (“cross-finger”), and can also be used in the reconstruction of digital defects of the feet (“crosstoe”). Here, the authors report a case where this flap was used after a wide excision of melanoma on the plantar aspect of the fifth toe. A 47-year-old otherwise healthy woman was referred to our department for assessment and treatment of melanoma of the plantar aspect of the distal phalanx of the fifth left toe. The excisional biopsy confirmed acral lentiginous melanoma with Breslow thickness of 1 mm, without ulceration and mitotic figures. We performed a wide local excision with safety margins of 1 cm and a biopsy of four sentinel lymph nodes in the ipsilateral inguinal region. The resulting skin defect encompassed the entire digital pulp of the fifth finger (Figure 1). To reconstruct this defect, a U-shaped transposition flap was designed, with a lateral pedicle on the dorsal surface of the fourth toe of the same foot (Figure 2). This flap was raised and sutured over the pulp defect of the fifth toe. To close the donor area on the fourth toe, a full-thickness skin graft was taken from the dorsum of the foot (Figure 3). The foot was immobilized in a plantar splint for 1 week. In the second step, 21 days later, the pedicle of the flap was sectioned. No perior post-operative complication occurred and the final result was satisfactory in terms of function and cosmetically acceptable (Figure 4). No micrometastases were found in any of the sentinel lymph nodes and the patient is free of disease after 3 years of follow-up. Treatment of digital cutaneous tumors is challenging due to several functional and cosmetic implications. Digital malignant melanoma is commonly treated with radical amputation or wide local excision to provide effective local control; however, concerns about avoiding mutilating surgery may arise.