University Center for Orthopedics, Trauma and Plastic Surgery, Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
Department of Dermatology, Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
World J Surg Oncol. 2023 Feb 6;21(1):38. doi: 10.1186/s12957-023-02923-z.
Extensive loss of soft tissue and bone due to neoplasia, trauma, or infection in extremities often leads to amputation.
We present the case of a 72-year-old female patient presenting with an extended cutaneous squamous cell carcinoma of the lower leg, developed on top of necrobiosis lipoidica. After achieving the R0 resection, a 26 × 20-cm soft tissue and 15-cm tibial bone defect resulted. The contralateral leg had been lost due to the same disease 18 years before. We achieved a successful reconstruction of the leg using a pedicled fibula transplantation, an extended anterolateral thigh perforator flap, and an internal fixation with plate and screws. Two years after the original surgery, the patient is relapse-free and mobile, with adequate function of the reconstructed foot.
Our case presented a unique combination of pedicled fibula transplantation and free extended ALT perforator flap to reconstruct an extensive defect after resection of a rare cSCC on top of NL. In selected cases, the boundaries of limb salvage can be pushed far beyond the current standards of treatment.
由于四肢的肿瘤、创伤或感染而导致的广泛软组织和骨丢失，通常会导致截肢。
我们报告了一例 72 岁女性患者的病例，她患有小腿下部广泛的皮肤鳞状细胞癌，继发于脂性渐进性坏死。在达到 R0 切除后，出现了 26×20 厘米的软组织和 15 厘米的胫骨骨缺损。18 年前，由于同一疾病，她的对侧下肢已经截肢。我们使用带蒂腓骨移植、扩展的前外侧股穿支皮瓣和钢板螺钉内固定成功地重建了腿部。在最初手术后的两年，患者无复发且行动自如，重建足的功能良好。
我们的病例呈现了一种独特的组合，即带蒂腓骨移植和游离扩展的前外侧股穿支皮瓣，用于重建罕见的 NL 上 cSCC 切除后广泛的缺损。在选择的病例中，可以将肢体保存的范围远远推过目前的治疗标准。
