Beyond the Knife: Integrating Near-Infrared Fluorescence Imaging in Complex Gluteal Tumor Resection and Reconstruction.

Malignant chondroid syringoma (MCS) is an exceptionally rare cutaneous adnexal tumor arising from sweat gland epithelium. The standard treatment involves wide local excision with clear margins, frequently followed by regional lymphadenectomy and flap reconstructive surgery. In anatomically complex regions such as the gluteal area, achieving both oncologic safety and reliable soft-tissue coverage poses significant surgical challenges. In this context, fluorescence-guided surgery (FGS) has emerged as a valuable intraoperative adjunct. Utilizing indocyanine green (ICG), FGS enables real-time perfusion mapping and enhanced visualization of tissue vascularity, thereby improving flap planning and inset accuracy. This is the case of a 51-year-old female patient who underwent radical resection of a large gluteal MCS and ipsilateral lymphadenectomy, followed by advancement flap reconstruction guided by near-infrared (NIR) fluorescence imaging using the novel IC-Flow 2™ system (Diagnostic Green Ltd, Munich, Germany).