Indication and selection and effect for application of skin flap to repair scar carcinoma in the lower leg and ankle

Objective: To explore the indication, selection and clinical effect for application of skin flap to repair scar carcinoma in the lower leg and ankle. Methods: A retrospective cohort study was conducted. From June 2008 to December 2018, six patients with scar carcinoma in the lower leg and ankle were treated in Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University. Six cases were all male, aged 48-64 years, with the area of lesion ranging from 3 cm×2 cm to 15 cm×6 cm. After extended resection, the defect area ranged from 8 cm×5 cm to 22 cm×9 cm, with tissue of tendon, bone, etc. exposed. Free anterolateral thigh perforator flap, latissimus dorsi myocutaneous flap or pedicled sural neurovascular flap was selected to repair the wound, according to the location of the wound in the lower extremity, selection of operation position, the location of the anastomotic vessels in the recipient area, and whether there was good skin and soft tissue available in the lower leg. The size of the flap was 11 cm×8 cm-26 cm×10 cm. The donor site of free flap or myocutaneous flap was closed directly by suture in 5 cases, and the donor site of pedicled flap was repaired with full-thickness skin graft in 1 case. The blood supply and survival of skin flap, survival quality of skin graft, and complication were observed postoperatively. During the follow-up period, the recurrence and metastasis of scar carcinoma, the appearance and function of donor and recipient sites were observed. Results: All the patients completed the operation successfully, all the transplanted skin flaps survived with good blood supply, and the skin graft in one donor area survived well. The donor and recipient wounds of all the patients healed well without infection, effusion, or dehiscence, etc. All the patients were followed up from 1 to 5 years. No local recurrence or distant metastasis of scar carcinoma was found. The quality of the transplanted skin flaps were good. The shape of the recipient area was satisfactory and the function of the affected limb was good. The appearance of the donor area was good without dysfunction. Conclusions: Skin flap transplantation is suitable for the patients with tendon and bone exposure after the excision of scar carcinoma in lower leg and ankle. The skin flap can be selected according to the location of scar carcinoma, operation position, the location of anastomotic vessels in the recipient area, and whether there is good skin and soft tissue available in the lower leg. The free anterolateral thigh perforator flap or latissimus dorsi myocutaneous flap is an ideal choice for repair, which can obtain large skin and soft tissue, and the donor site can be directly sutured without affecting the function.