No abstract

Non-salvageable extremities have been utilized for harvesting fillet flaps as part of the "spare parts" concept in traumatic and oncologic settings. Here we report on the use of a pedicled fillet flap of the upper arm for chest wall reconstruction after excision of a malignant peripheral nerve sheath tumor in a patient with neurofibromatosis. Pedicled flaps as part of the "spare parts" concept provide the advantage of reduced donor-site morbidity, immediate closure, intact vasculature, and adequate soft tissue coverage of large defects. Malignant peripheral nerve sheath tumor is a rare aggressive tumor with a poor prognosis that may result in large defects post resection. Limited data describes the use of pedicled fillet flaps of the upper extremity. We report the use of a pedicled fillet flap of the upper arm as a viable option that can be successfully used for coverage of soft tissue defects of the shoulder and chest wall post complex resections in an oncologic setting.

A 53-year-old male complained of gradual, painless dimness of vision with swelling of the right eye (R/E) for 15 days. Best-corrected visual acuity in R/E: Hand movement, left eye: 6/9, abaxial proptosis, restricted extraocular movements in all directions, conjunctival injection, and high intraocular pressure R/E were noted. Fundus showed pale optic disc R/E and macular exudates in both eyes. The patient was diabetic and on oral hypoglycemic agents with raised erythrocyte sedimentation rate and C-reactive protein; random blood sugar: 152 mg/dL. Magnetic resonance imaging (MRI) showed right-sided orbital abscess involving extraconal compartment extending into the right orbital apex with compression of the right optic nerve. Mantoux test was positive and computed tomography thorax was normal. Histopathology of biopsy from middle turbinate showed granulomatous inflammatory cellular lesion. The patient was started on anti-tubercular therapy. He got relieved of symptoms. Repeat MRI showed reduction in disease process.

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