Limb-sparing reconstruction of acral lentiginous melanoma on the plantar foot using biodegradable temporizing matrix and split-thickness skin grafting: a case report

Acral lentiginous melanoma, a rare and aggressive melanoma subtype, often affects weight-bearing areas like the sole of foot, presenting complex reconstructive challenges after wide local excision. An 87-year-old female chiropodist with a 4.5-cm, 1-mm thick ALM on her left ball of foot underwent wide local excision with 1-cm margins, preserving hallux neurovascular bundles and achieving complete excision. Reconstruction utilized a biodegradable temporizing matrix (BTM) with negative pressure wound therapy for 5 weeks, followed by split-thickness skin grafting (SSG) after BTM delamination. She remained non-weight-bearing during recovery and regained full foot function long-term. BTM with SSG facilitates robust neodermis formation, offering an effective alternative to flap reconstruction, especially in elderly patients or defects with exposed bone or tendon, avoiding donor site morbidity while ensuring favorable functional outcomes with early ambulation and low complication rates. This approach highlights a shift toward limb-sparing techniques over amputation for plantar ALM in appropriately selected patients.