Palmoplantar keratodermas may present to the clinician with an extremely broad series of clinical findings. Management has also taken on a wide variety of medical and surgical modalities. The literature seems to provide evidence that optimum management consists of surgical excision with skin grafting. It is believed that this will eliminate all of the underlying tissue and associated skin appendages, which are believed to be the source of this abnormal skin entity. We present a case of a patient in which tangential excision with delayed split-thickness skin grafting was performed after initial application of an acellular dermal matrix (Integra). Unfortunately, there was nearly immediate recurrence of this disease, and we, therefore, suggest a more aggressive approach to the initial excision.
From the *Division of Plastic and Reconstructive Surgery, and †Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida.
Received May 18, 2009.
Accepted for publication May 30, 2009.
Address correspondence and reprint requests to Seth R. Thaller, MD, DMD, Division of Plastic and Reconstructive Surgery, Miller School of Medicine, University of Miami, 1611 NW12th Ave ET3019, Miami, Florida 33101; E-mail: SThaller@med.miami.edu