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

Research output: Contribution to journalResearch articleContributedpeer-review


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.


Original languageEnglish
Article number38
JournalWorld journal of surgical oncology
Issue number1
Publication statusPublished - Dec 2023

External IDs

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


Sustainable Development Goals

ASJC Scopus subject areas


  • 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