Merkel cell carcinoma (MCC) is a rare, but highly aggressive, malignant neuroendocrine tumor, with a higher prevalence in men, Caucasians, and the elderly. It is usually identified in photo-exposed areas such as the head, trunk, and extremities. It is related to locoregional recurrences and metastases, which conditions a high mortality rate. Currently, the pathogenesis is unclear, but it is related to ultraviolet radiation, immunosuppression, and polyomavirus infection. Prompt diagnosis and treatment are essential to improve the survival rate.

One of the recurring problems in plastic and reconstructive surgery is the loss of tissues of the lower extremities as a result of high-energy injuries. The difficulty of this reconstruction lies in the need for a sufficiently suitable and resistant tissue to allow this restoration. The thigh-free anterolateral flap, since its description in 1984, has great versatility for complex or extensive lower extremity reconstructions. We presented the case of a 37-year-old male patient who had a high-energy road accident on a bicycle, impacting a moving vehicle causing a multi fragmented fracture of the right proximal tibia AO 41 C2.2/Schatzker V. He was treated surgically with material from osteosynthesis and iliac crest graft. It is complicated by infection of the surgical wound, exposure of osteosynthesis material and absence of skin covering. Reconstruction of the upper third of the right leg was performed with a thigh-free anterolateral free flap with 2 end-to-end venous anastomoses from the flap to anterior tibial veins, and 1 end-to-end anastomosis from perforating artery to anterior tibial artery, with no associated complications. The thigh-free anterolateral free flap is a versatile and reliable mechanism for the reconstructive surgeon, as it provides excellent coverage for complex lower extremity wounds as well as low donor site morbidity. Outpatient follow-up with adequate clinical evolution was done.

Gallstone ileus represents a complication of cholelithiasis, which in the literature has been reported as a rare cause of mechanical intestinal obstruction, however, the reported incidence is not so low, especially after 65 years of age. The formation of a bilioenteric fistula allows the passage of a large gallstone into the intestine, usually impacting the distal intestine. It is associated with a mortality that ranges between 12 and 27%. Treatment is surgical, although there is no consensus on which of the surgical techniques is the one of choice. We report the case of an 87-year-old male patient who was admitted to the emergency department with intestinal obstruction. He was diagnosed with gallstone ileus and was treated surgically with exploratory laparotomy, enterotomy with stone extraction, and primary closure. The evolution was favorable and without complications.