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.