Arch Hand Microsurg.  2018 Mar;23(1):54-58. 10.12790/ahm.2018.23.1.54.

Reconstruction of Heel Defect Occured by Verrucous Carcinoma

• Ahn SK
• Choi HJ
• Jang SH

• KMID: 2412491
• DOI: http://doi.org/10.12790/ahm.2018.23.1.54

Abstract

Verrucous carcinoma is a low-grade, well differentiated uncommon variant of squamous cell carcinoma and may grow large and can destroy adjacent tissue such as bone and cartilage. A 45-year-old male patient presented with chief complaints of growth mass of the left foot. He is known diabetic, hypertensive, chronic venous insufficiency and related ulcerations on the lower legs. There is a tender, ulcero-proliferative mass on foot. The result of biopsy showed a highly differentiated verrucous carcinoma. At first the patient underwent wide excision and biopsy with mesh split thickness skin graft. But after 4 months that surgery, verrucous carcinoma recurred with ulceration. Because tumor infiltrated the soft periosteal tissues and calcaneus, he need flap coverage or amputation. We decide to reconstruct heel with anterolateral thigh perforator free flap. The goal of heel reconstruction should be functional and aesthetic. Below knee amputation was not performed, so the patient's quality of life increased.

Keyword

Verrucous carcinoma; Anterolateral thigh free flap; Heel defect; Amputation; Diabetic foot

MeSH Terms

Amputation
Biopsy
Calcaneus
Carcinoma, Squamous Cell
Carcinoma, Verrucous*
Cartilage
Diabetic Foot
Foot
Free Tissue Flaps
Heel*
Humans
Knee
Leg
Male
Middle Aged
Quality of Life
Skin
Thigh
Transplants
Ulcer
Venous Insufficiency

Figure

• 

  Fig.1. Preoperative image of the ulcerative masses on both the ankle and heel.

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  Fig.2. After wide excision of the mass on the left foot and debridement.

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  Fig.3. Recurrence of verrucous carcinoma on the heel.

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  Fig.4. (A) The tumor showed a downward growing solid bulbous infiltrative nest (H&E, ×12.5). (B) The tumor consisted of well differentiated squamous cells (H&E, ×400).

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  Fig.5. After 1 year follow-up of anterolateral thigh free flap operation.

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