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

Publikation: Beitrag in FachzeitschriftForschungsartikelBeigetragenBegutachtung


Background: Extensive loss of soft tissue and bone due to neoplasia, trauma, or infection in extremities often leads to amputation. Case presentation: We present the case of a 72-year-old female patient presenting with an extended cutaneous squamous cell carcinoma of the lower leg, developed on top of necrobiosis lipoidica. After achieving the R0 resection, a 26 × 20-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 successful 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 relapse-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.


FachzeitschriftWorld journal of surgical oncology
PublikationsstatusVeröffentlicht - Dez. 2023

Externe IDs

PubMed 36747272
ORCID /0000-0003-4633-2695/work/145698759
ORCID /0000-0003-4340-9706/work/145698959


Ziele für nachhaltige Entwicklung

ASJC Scopus Sachgebiete


  • Anterolateral thigh perforator flap, Extended cutaneous scquamous cell carcinoma, Necrobiosis lipoidica, Pedicled fibula transplantation, Reconstructive microsurgery, Surgical oncology, Skin Neoplasms/surgery, Fibula/surgery, Humans, Necrobiosis Lipoidica/surgery, Treatment Outcome, Thigh/surgery, Neoplasm Recurrence, Local/surgery, Perforator Flap, Carcinoma, Squamous Cell/surgery, Plastic Surgery Procedures, Female, Aged, Leg/surgery