Implantation of Squamous Cell Carcinoma in a Free Flap Donor Site

Pichardo, Priscilla; Purdy, Nicholas; Haugen, Thorsen W.

doi:10.1177/0003489420917418

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…Metastatic SCC was discovered in a donor-site nodule 6 months after reconstruction. 15 Zhou et al described a young adult with a left cheek sclerosing rhabdomyosarcoma reconstructed with a left ALT free flap. 4 A 6-month surveillance whole-body FDG-PET demonstrated an intramuscular mass at the left rectus femoris muscle, confirmed as donor site metastasis.…”

Section: Discussionmentioning

confidence: 99%

Oral Squamous Cell Carcinoma Metastasis to Anterolateral Thigh Flap Donor Site: A Case Report

Chiang,

Lee

2023

Plastic and Reconstructive Surgery - Global Open

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Summary: In the realm of oncologic reconstructive surgery, local or distant autologous tissue is frequently used to improve function and appearance. Due to advances in microsurgery and intensive care, reconstructive free flap surgery has become the standard treatment for head and neck cancer. However, the complexity of interdisciplinary intervention and prolonged surgical time inevitably increase the risk of cross-contamination, potentially leading to donor site metastasis. According to the literature, tumor transmission to the donor site of free flaps is extremely rare. We present the case of a 54-year-old man with left tongue squamous cell carcinoma. Three months after tumor ablation and reconstruction with a free anterolateral thigh flap, the patient presented with a mass on the donor site of the left thigh, which was proven to be a metastasis. A systemic workup revealed multiple metastases. Six months after reconstruction, the patient died of COVID-19 pneumonia. The incidence and risk factors of donor site metastasis are not well known. The primary causes are direct implantation or hematogenous spread. Cross-contamination is primarily prevented by the surgeon’s awareness and avoidance. The development of new-onset lesions at the donor site warrants additional testing to detect systemic disease progression during follow-up.

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Section: Discussionmentioning

confidence: 99%

Oral Squamous Cell Carcinoma Metastasis to Anterolateral Thigh Flap Donor Site: A Case Report

Chiang,

Lee

2023

Plastic and Reconstructive Surgery - Global Open

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“…Pai et al described a case of iatrogenic implantation of high grade spindle cell sarcoma to the left thigh that occurred 8 years after initial surgery 12. Of note, there are infrequent reports of head and neck primary cancers with isolated graft/flap donor site metastasis or percutaneous endoscopic gastrostomy tumour implantation 13–16. In theory, although unlikely, cross-contamination might inadvertently occur somewhere along the course of the prolonged and complex head and neck surgery 14.…”

Section: Discussionmentioning

confidence: 99%

“…Of note, there are infrequent reports of head and neck primary cancers with isolated graft/flap donor site metastasis or percutaneous endoscopic gastrostomy tumour implantation 13–16. In theory, although unlikely, cross-contamination might inadvertently occur somewhere along the course of the prolonged and complex head and neck surgery 14. There are preventative strategies for oncologic resection and reconstruction to prevent surgical contamination.…”

Section: Discussionmentioning

confidence: 99%

Left cheek sclerosing rhabdomyosarcoma and development of isolated free flap donor site metastasis

et al. 2022

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Rhabdomyosarcoma is a rare mesenchymal malignancy with four different morphological subtypes: alveolar, embryonal, pleomorphic and spindle cell/sclerosing. It is the most common soft tissue sarcoma of children and adolescents but occurs less commonly in adults. We describe a male patient in his 20s with sclerosing rhabdomyosarcoma of the left cheek who developed an isolated free flap donor site metastasis in the first instance but subsequently progressed with bilateral pulmonary metastases. Multidisciplinary team involvement in a sarcoma specialist centre is essential and collaboration between the pathologist, radiologist, head and neck surgeon, orthopaedic surgeon, radiation oncologist and medical oncologist were integral in providing optimal management in this patient. Furthermore, this case report highlights this phenomenon of implantation metastasis in a patient with rhabdomyosarcoma, and emphasises the importance of surgical barriers between the resection and reconstruction teams in an oncological case.

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“…Since then, there are various descriptions of implantation of SCC, including breast cancer seeding along the needle track of core biopsy [8], chest wall implantation following lung tumor biopsy, or abdominal wall implantation following a percutaneous endoscopic gastrostomy (PEG) tube insertion [9]. Few cases of donor site metastasis after pectoralis major myocutaneous flap reconstruction for oral SCC have been reported till date [10,11], but the implantation of SCC at the free flap donor site is relatively rare, only a small number of cases have been reported in the literature [12]. The possible mechanism of spread in our case is accidental contamination of flap handling instruments with tumor cells resulting in metastatic implantation at the donor site.…”

Section: Discussionmentioning

confidence: 99%