Soft-tissue sarcomas (STS) are rare solid tumors of mesenchymal cell origin and account for only 1% of adult malignancies. They tend to occur most commonly in the lower extremities. Reconstruction after sarcoma resection can be challenging, especially when important structures are involved and recurrences occur. Additionally, more attention is now being paid to reconstructing the lymphatic system to prevent lymphatic complications. In this case report, we presented the management of recurrent medial thigh sarcoma that necessitated multiple challenging reconstructions to provide valuable insights for lectures on similar cases. A 50-year-old male patient was diagnosed with an undifferentiated pleomorphic cell sarcoma (UPS) of the anteromedial thigh. After preoperative radiotherapy, a mass of 23 × 15 cm was removed, and reconstruction with a pedicled deep inferior epigastric artery perforator (p-DIEP) flap-based lymphatic flow through (LyFT) was performed. Six months later, the patient developed the first local recurrence with the presence of a distant metastasis. Following the tumor resection, the medial part of the DIEP flap was de-epithelized and buried in the defect for dead space obliteration. Another local recurrence arose 7 months after the second surgery. Therefore, a major debulking surgery involving the femoral neurovascular bundle was performed. The femoral artery was reconstructed with a synthetic graft, and the femoral vein with the great saphenous vein harvested from the contralateral thigh. A composite myocutaneous neurotized anterolateral thigh (ALT) flap from the contralateral thigh was used to obliterate the defect and restore the loss of function of the quadriceps femoris. Two lymphaticovenular anastomoses (LVAs) were performed at the ankle to reduce the risk of lymphatic sequelae. This case report highlights the importance of integrating various techniques to create a tailored approach that effectively addresses complex surgical requirements to avoid limb amputation and maintain functionality.

Parry Romberg syndrome also known as progressive hemifacial atrophy is an uncommon degenerative condition, characterized by unilateral, slow, and progressive atrophy of face. Patient presents with loss of facial symmetry and neurological manifestations. After the degenerative process settles, reconstructive surgeries are performed to address facial asymmetry. For accurate assessment of volume deficit, laser scanning and three- dimensional printing can be used which offers the advantage of precise surgical planning and good aesthetic outcome. We present a case of soft tissue reconstruction in Parry Romberg syndrome with anterolateral thigh flap with use of three- dimensional laser scanning.

The present study aimed to investigate outcomes following open surgery for extensive skull base ORN. Open surgery through a personalized sequential approach was employed to deal with five cases of extensive skull base ORN. Two patients with mild cases underwent regional debridement and sequestrectomy, and three patients with severe cases underwent extensive resection with reconstruction using free anterolateral thigh (ALT) flap. Biological glues and vascularized flaps were used for obturation of the skull base bony defect to prevent postoperative cerebrospinal fluid (CSF) leakage. The infections were controlled by antibiotic administrations which strictly followed the principles of antimicrobial stewardship (AMS). As results, both regional debridement plus sequestrectomy and extensive resection achieved satisfied outcomes in all patients. No severe complications and delayed hospitalization occurred. During the follow-up period (8-19 months), all patients were alive, pain free, without crusting or purulent discharge, and no sequestration or CSF leakage occurred. In conclusion, a personalized sequential approach including open surgery, pedicled/vascularized free flap reconstruction and AMS was advocated for patients with extensive skull base ORN.

BACKGROUND: Persistent complex defects and dysfunctions of the upper aerodigestive tract after tumor surgery represent a major challenge. The aim of this study was to evaluate the effectiveness of an interdisciplinary approach using the free anterolateral thigh flap (ALT) as a reconstruction option in the upper aerodigestive tract.
METHODS: The retrospective study identified 5 patients with complex defects after laryngectomy/pharyngolaryngectomy (LE/PLE) and multiple revision surgeries between 2017 and 2023. The operations were performed by an interdisciplinary team from otolaryngology, plastic surgery, and visceral/thoracic surgery. The results of the microsurgical reconstruction were analyzed.
RESULTS: There was an average of six previous operations. The defects included tracheoesophageal fistulas, pharyngocutaneous fistulas, neopharyngeal stenosis, and combinations thereof. Successful reconstruction was achieved in 100% of patients using the ALT flap. In 2 patients, ALT flow-through flaps were used with an additional free jejunal interposition (JI) and in 3 patients split-ALT flaps were used. The major complication rate was 40% and the minor complication rate was 20%.
CONCLUSIONS: Complex defects of the upper aerodigestive tract with multiple previous operations can be successfully reconstructed. Because of its versatility, the ALT flap seems to be a very good option. Prerequisite for this is an interdisciplinary treatment approach with a critical assessment of patient- and disease-specific factors.
UNASSIGNED: HINTERGRUND: Persistierende komplexe Defekte und Funktionsstörungen des oberen Aerodigestivtrakts nach tumorchirurgischen Eingriffen stellen eine große Herausforderung dar. Ziel dieser Studie war es, die Wirksamkeit eines interdisziplinären Ansatzes mit der freien lateralen Oberschenkellappenplastik (ALT) als Rekonstruktionsoption im oberen Aerodigestivtrakt zu evaluieren.
METHODS: Die retrospektive Studie identifizierte zwischen 2017 und 2023 5 Patient*innen mit komplexen Defekten nach Laryngektomie (LE) und multiplen Revisionsoperationen. Die Operationen erfolgten durch ein interdisziplinäres Team aus HNO, Plastischer Chirurgie und Viszeral‑/Thoraxchirurgie. Die Ergebnisse der mikrochirurgischen Rekonstruktion wurden erfasst.
UNASSIGNED: Es lagen durchschnittlich 6 Voroperationen vor. Die Defekte umfassten tracheoösophageale Fisteln, pharyngokutane Fisteln, Neopharynxstenosen sowie deren Kombination. Eine erfolgreiche Rekonstruktion konnte in 100 % der Fälle durch den ALT-Lappen erreicht werden. In zwei Fällen wurden ALT-Durchflusslappen mit einem zusätzlichen Jejunuminterponat (JI) und in drei Fällen ein Split-ALT-Lappen durchgeführt. Die Major-Komplikationsrate lag bei 40 % und die Minor-Komplikationsrate bei 20 %.
UNASSIGNED: Komplexe Defekte des oberen Aerodigestivtrakts mit multiplen Voroperationen können erfolgreich rekonstruiert werden. Aufgrund seiner Vielseitigkeit scheint der ALT-Lappen eine sehr gute Option zu sein. Voraussetzung hierfür ist ein interdisziplinärer Behandlungsansatz mit einer kritischen Abwägung der patienten- und krankheitsspezifischen Faktoren.

Abdominal wall reconstruction aims at restoring the anatomical, functional and aesthetic integrity of this region, while providing protection of abdominal viscera and prevent herniation. There are various techniques used for abdominal wall reconstruction. We present a difficult case of abdominal wall reconstruction performed with a pedicled antero-lateral thigh (ALT] flap with good postoperative results.

UNASSIGNED: The pedicled anterolateral thigh flap is a versatile flap that offers many advantages. These include a long and reliable pedicle that enables a wide arch of rotation, the possibility to harvest a large skin area, raising the flap with underlying fascia and muscle and minimal donor site morbidity.
UNASSIGNED: From 2009 to 2018 nine patients were reconstructed with a pedicled anterolateral thigh flap. The flap was applied for coverage of knee infections, trochanteric defects, an abdominal defect, a gluteal defect, and a defect of the inguinal region. The patient group consisted of five males and four females. The age range was 30-90 years with a mean age of 61 years.
UNASSIGNED: Flap size ranged from 10 x 5 cm (50 cm2) to 15 x 30 cm (450 cm2) with a mean size of 222 cm2. We experienced no flap loss. The donor site was closed directly in seven out of nine patients, and the remaining two patients were closed by split-thickness skin grafting. Satisfactory aesthetic and functional outcome was achieved in all patients.
UNASSIGNED: Our experience illustrates the versatility in the clinical application of the pedicled anterolateral thigh flap. The many advantages of the flap, such as the long and reliable pedicle, a large area of skin that can be harvested, the potential to supercharge the flap and the minimal donor site morbidity highlights the diversity of defects that can be reconstructed using this flap.

BACKGROUND: Dermatofibrosarcoma protuberans (DFSP) is a cutaneous malignancy that arises from the dermis and invades deeper tissue. The cellular origin of DFSP is not clear. Evidence supports the cellular origin being fibroblastic, histiocytic, or neuroectodermal.
METHODS: A 38 years old, women presented with slow-growing large right parotid mass. A total parotidectomy performed with auriculectomy and reconstruction using ALT flap. Diagnosis confirmed by pathology and immunohistochemistry. Tumor recurred in 10 months, the second surgery with subsequent chemoradiotherapy performed. Patient initially treated with wide resection, 4 cycles of chemotherapy and postoperative radiotherapy 40 Gy, with the recurrence in 10 months. We performed a second surgery followed by radiotherapy. She is disease-free for more than two years under follow-up.
CONCLUSIONS: The main treatment of DFSP is surgical resection with wide negative margins or Moh\'s surgery. Advanced cases treated with addition of radiotherapy or chemoradiotherapy, but with unclear benefits. In our case, huge tumor located in the parotid region recurred after initial surgery and adjuvant treatment.
CONCLUSIONS: Clinically, DFSP usually manifest as well circumscribed, slow-growing, smooth, and painless masses. In cases with advanced tumor in parotid region, recurrence may occur despite aggressive initial treatment with wide resection and chemoradiotherapy.

Composite upper extremity defects involving muscle-tendon units are amongst the most formidable reconstructive challenges and mandate functional restoration in addition to stable soft-tissue coverage. Here, the authors present a case of a composite defect involving the extensor muscle-tendon units of the forearm resulting from surgical resection of a recurrent Merkel cell cancer. Functional restoration was achieved via multiple tendon transfers followed by soft tissue coverage with a free anterolateral thigh (ALT) flap. No donor- or recipient-site complications were encountered and complete flap survival was noted. Following a 6-week period of immobilization, physical therapy and range of motion exercises were initiated. Excellent functional outcome and high patient satisfaction were noted at 8 weeks postoperatively. In summary, simultaneous tendon transfers and microsurgical tissue transfer may provide a potentially superior approach for upper extremity reconstruction in complex composite defects. © 2014 Wiley Periodicals, Inc. Microsurgery 37:71-74, 2017.