Lower leg reconstruction after resection of a squamous cell carcinoma on necrobiosis lipoidica with a pedicled fibula and an extended anterolateral thigh flap – A case report

Abstract

Background: Extensive loss of soft tissue and bone due to neoplasia, trauma or infection in extremities often lead to amputation. Case presentation: We present the case of a 72 year old female patient presenting with an extended cutaneous scquamous cell carcinoma of the lower leg, developed on top of necrobiosis lipoidica. After achieving the R0 resection, a 26X20 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 successfull 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 relaps-free and mobile, with adequate function of the reconstructed foot. Conclusions: 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.