Extracorporeal Perfusion for Free Fillet Lower Leg Flap After External Hemipelvectomy for Recurrent Osteosarcoma: A New Surgical Technique

BackgroundExternal hemipelvectomy often results in exposure of noble structures such as pelvic organs, joint surfaces, iliac neurovascular bundle and bone. Consequently, reconstructive surgery is always challenging. The free fillet lower leg flap is an optimal solution since it allows the transfer of a large amount of tissue and the it determines the absence of donor site morbidities. The prolonged ischemic time represents the weak point of this flap.Methods We presented the case of a 38-year-old man with recurrent radio-induced osteosarcoma arisen on pelvic cavity and involving common iliac vessels, bladder, left ureter and left kidney. We decided to use extracorporeal circulation (ECMO) in order to reduce ischemic time of the flap, since iliac vessels were necessary ligated in the middle of oncologic resection. We perfused the popliteal-based filleted lower leg musculocutaneous free flap with homologue blood and saline solution, while the oncologic dissection was completed.ResultsThe free fillet flap remained vital in the immediate postoperative period and in the following months. The patient did not come back to a life-threatening condition at 1y follow-up. ConclusionWe believed that ECMO expand the reconstructive indications in those cases in which a complex and long-lasting oncologic resection would make impossible a free flap due to prolonged ischemic time.

Temporalis Muscle Flap for the Immediate Reconstruction of Oral Defects after Oncologic Resection

An oral defect after oncologic resection, especially in the upper jaw, is an extremely complex problem in terms of reconstructive surgery. Herein, we report 2 patients who were diagnosed with oral mucosal squamous cell carcinoma. In one patient, the lesion was present on the right side of the hard palate, invading the maxillary bone. In the other patient, the lesion was present in the left retromolar trigone region. Reconstruction of the postsurgical defects was successfully done using a temporalis muscle flap. Both patients were discharged after ensuring the absence of any postsurgical complications. Furthermore, the postoperative functional and esthetic outcomes were adequate. These case reports highlight the usefulness and reliability of a temporalis muscle flap for the immediate reconstruction of oral and maxillary defects after oncologic resection.

Plastic Surgeons Add Value in Upper Extremity Melanoma Oncologic Resection and Reconstruction

We present a pediatric patient with an ASMT of the wrist with the unique approach of a plastic and reconstructive surgeon to surgical oncologic resection and reconstruction: WLE, ICG and NIRF imaging-assisted SLNB followed by reconstruction with a keystone perforator flap.