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Abstract：
Split-thickness skin grafts are often applied in the management of primary cutaneous melanoma. It is routine surgical practice to use the contralateral limb because of the alleged risk of donor site metastases that may occur when the ipsilateral limb is used. The rationale and clinical evidence for this routine were assessed in light of current understanding of pathways of metastasis of melanoma. We found the preference for the contralateral limb to go back to Paget\'s ideas on melanoma spread from 1889, and the clinical observation of five cases of split-thickness skin graft donor site metastases in a series of 226 tumours, published in 1962. We traced ten additional reported cases of melanoma metastases occurring in the skin graft donor site. Contralateral donor sites were involved in seven of these cases. In light of current knowledge, the occurrence and the location of any split skin donor site metastasis are to be considered as mere indicators of an aggressive course of systemic disease. Any location of a split skin donor site, whether ipsilateral or contralateral in relation to the primary tumour, may become the location of metastases but chances that such metastases occur are extremely rare. Because of the lack of evidence in favour of the use of the contralateral limb and because of sound considerations in favour of using the ipsilateral limb, we conclude that there is no objective argument to sustain the dogmatic ban of the ipsilateral limb as a donor site for a split-thickness skin graft in melanoma surgery.
摘要：
厚薄的皮肤移植物通常用于原发性皮肤黑色素瘤的治疗。常规手术实践是使用对侧肢体,因为当使用同侧肢体时可能发生供体部位转移的据称风险。根据目前对黑色素瘤转移途径的理解，对该常规的基本原理和临床证据进行了评估。我们发现对侧肢体的偏好可以追溯到1889年Paget关于黑色素瘤扩散的观点，并在一系列226个肿瘤中对5例分裂厚度皮肤移植供体部位转移的临床观察，1962年出版。我们追踪了另外10例报道的皮肤移植供体部位发生的黑色素瘤转移病例。其中7例涉及对侧供体部位。根据目前的知识，任何分裂的皮肤供体部位转移的发生和位置被认为仅仅是全身性疾病侵袭性过程的指标。分裂的皮肤供体部位的任何位置，无论是与原发性肿瘤相关的同侧还是对侧，可能成为转移的位置，但这种转移发生的机会非常罕见。由于缺乏支持使用对侧肢体的证据，并且由于支持使用同侧肢体的合理考虑，我们得出的结论是,在黑色素瘤手术中,没有客观的论据可以维持将同侧肢体作为供体部位的教条禁令.
