The staged forearm and leg interpolation flap in the treatment of cutaneous squamous cell carcinoma: A retrospective case series

Abstract

Among approaches for the treatment of cutaneous squamous cell carcinoma (cSCC), complete surgical removal at the primary tumor site should be the first-line treatment when tumor characteristics (size, location, and number) allow. 1 Mohs micrographic surgery (MMS) is the gold standard for the treatment of cSCC, with a cure rate of 96%-99%. 2 Wide local excision (WLE) is another type of treatment with a cure rate of 90%-97%, and it can be used when MMS is not available or indicated. 3 No difference was found in the 5-year cure rate between MMS and WLE. 4 WLE with an interpolation flap was used F I G U R E 1 Forearm and leg rotational interpolation flap for three cases with cSCC. (A-C) Case 1 before and after WLE with a second surgery. (A). The bleeding, ulcerative tumor was in the left dorsum of the hand, and the diameter was approximately 30 mm before treatment. (B). A rotational interpolation flap was subsequently designed to incorporate a template along the proximal radial forearm. (C). Completion of the second stage. The interpolation flap survived well, and after the second surgery, the flap was used to reconstruct the defect. (D-F) Preoperative and postoperative appearance of case 2. (D). A template of the defect was made and marked along ulnar proximal skin (purple-marked line). (E). A combined rotation and interpolation flap for the treatment of neoplasms in the ulnar forearm. (F). Division of the pedicle was performed. After the secondary stage of surgery, a light skin ulcer was found in the flap. (G-J) Appearance of the two stages of case 3 in approximately one and a half months. (G). The neoplasm was in the left lower leg, and the diameter was approximately 20 mm. (H). A local rotational flap was inserted from the proximal lower leg into the defect. (I). After the second surgery, the interpolation flap survived well. (J). Ten days after the second surgery, the flap was used to reconstruct the defect. cSCC, cutaneous squamous cell carcinoma; WLE, wide local excision