Background: Reconstruction after wide excision of melanoma must preserve oncologic integrity while restoring function and appearance. Microsurgical free flaps provide durable coverage in complex cases, whereas local flaps remain favored for smaller defects. Current literature lacks direct comparisons in advanced melanoma. Methods: A review of PubMed, Scopus, and Web of Science (2010–2024) identified ten studies, including retrospective cohorts, matched analyses, and systematic reviews. Outcomes analyzed included flap survival, recurrence, patient satisfaction, and functional recovery (e.g., VAS-FA). Study quality was assessed using CASP tools. Results: Free flaps achieved 94–100% survival with preserved oncologic safety. In head and neck melanoma, one study suggested improved disease-specific survival (HR 0.26; p = 0.06). Microsurgical reconstruction yielded superior functional outcomes, including higher VAS-FA scores (>90) and earlier weight-bearing (9 days). Free flaps also outperformed local flaps in aesthetic satisfaction (mean 4.3 vs. 3.5; p = 0.04). Local flaps were associated with shorter hospital stays (4.75 vs. 9.8 days; p < 0.05) but higher revision and infection rates. Recurrence rates were comparable between techniques. Conclusion: Microsurgical free flaps provide superior functional and aesthetic results without compromising oncologic safety, while local flaps remain appropriate for small or simple defects. Reconstruction planning should consider defect size, location, and patient-specific factors. Standardized outcome measures are needed to support future comparative trials.
Guamán et al. (Thu,) studied this question.