Arch Hand Microsurg.  2024 Jun;29(2):116-121. 10.12790/ahm.23.0058.

Surgical treatment of extensive and multiple skin cancers via excision and reconstruction using multiple flaps: a case report

• Lee DDU
• Lee KT

• KMID: 2556362
• DOI: http://doi.org/10.12790/ahm.23.0058

Abstract

A 47-year-old male patient presented with multiple squamous and basal cell carcinomas on the anterior chest, back, and left cheek. The patient experienced odorous discharge from the tumors. Surgical excision was planned, beginning with the anterior chest squamous cell carcinoma. An extensive 32×30 cm cutaneous defect was created, which was covered by a bilateral deep inferior epigastric perforator and pedicled latissimus dorsi myocutaneous flaps. The basal cell carcinomas on the back and squamous cell carcinoma on the left cheek were serially excised, after which the left cheek wound required flap coverage. Postoperative complications such as venous thrombosis and infection led to several reoperations, yet the extensive defect was successfully reconstructed. No local recurrence developed during 31 months of follow-up. We report this case to demonstrate that although the wide excision of very large skin cancers may result in extensive and challenging defects as large as 5.8% of the total body surface area, coverage with appropriate flaps may lead to successful oncologic outcomes and improve the patient’s quality of life.

Keyword

Skin neoplasms; Multiple flaps; Chest wall reconstruction; Microsurgery

Figure

• 

  Fig. 1. (A) The extensive squamous cell carcinoma on the anterior chest wall measured 26.5×25 cm. (B) Multiple basal cell carcinomas were present on the patient’s back. (C) A staged excision was planned for the patient’s left cheek mass.

• 

  Fig. 2. (A) A 32×30 cm defect resulted on the anterior chest wall (4.4% loss of total body surface area). The pectoralis major muscle was excised due to cancer invasion. (B) The anterior chest wall mass was resected with a safety margin of 2 cm.

• 

  Fig. 3. (A) Bilateral deep inferior epigastric perforator (DIEP) flaps. (B) Anterolateral thigh (ALT) flap from the patient’s right thigh. (C) Right DIEP flap on the left chest, left DIEP flap on the right chest, and ALT flap on the lower side. (D) Initial vessel anastomoses. (E) Anastomosis after revisional surgery. Lt, left; IMA, internal mammary artery; LCFV, lateral circumflex femoral vein; LCFA, lateral circumflex femoral artery; DIEV, deep inferior epigastric vein; DIEA, deep inferior epigastric artery.

• 

  Fig. 4. Follow-up at 31 months postoperatively shows a clear wound with no sign of local recurrence.

Reference

References

1. Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023; 73:17–48.

2. Motley R, Kersey P, Lawrence C; British Association of Dermatologists; British Association of Plastic Surgeons. Multiprofessional guidelines for the management of the patient with primary cutaneous squamous cell carcinoma. Br J Plast Surg. 2003; 56:85–91.

3. Jarkowski A 3rd, Hare R, Loud P, et al. Systemic therapy in advanced cutaneous squamous cell carcinoma (CSCC): the Roswell Park experience and a review of the literature. Am J Clin Oncol. 2016; 39:545–8.

4. Bird C. Managing malignant fungating wounds. Prof Nurse. 2000; 15:253–6.

5. Pyo S, Joo H. 479 Vaccum-assisted closure therapy in split-thickness skin graft on the wound on the contours of the body. J Burn Care Res. 2019; 40(Suppl 1):S214–5.

6. Grocott P, Gethin G, Probst S. Malignant wound management in advanced illness: new insights. Curr Opin Support Palliat Care. 2013; 7:101–5.

7. Sim NHS, Ngaserin S, Feng JJ, et al. Reconstruction of a massive chest wall defect using a free anterolateral-lower medial thigh flaps: a case report. J Surg Case Rep. 2023; 2023:rjad264.