Extremity Salvage with a Free Musculocutaneous Latissimus Dorsi Flap and Free Tendon Transfer after Resection of a Congenital Fibrosarcoma in a 15-Week-Old Infant

A case of complex microsurgical reconstruction of the dorsum of the foot, including tendon transfer following tumor resection in a 15-week-old male infant, was presented.

After birth, a 5.5 × 4-cm large tumor was observed on the dorsum of the right foot. Biopsy showed a congenital malignant fibrosarcoma. After four cycles of chemotherapy according to the CWS 2002 protocol, a radical excision of the tumor at the age of 14 weeks followed. Skin, extensor tendons, capsule of the ankle joint, anterior tibial artery and nerve, greater and lesser saphenous vein were removed, leaving a defect of 6.5 × 5 cm in diameter and exposing the posterior skeleton of the foot and ankle, as well as the distal tibia. Macroscopically, a security margin of 1 cm on the cutaneus level was maintained. The defect was temporarily covered with artificial skin substitute. To cover the defect, a musculocutaneus latissimus dorsi flap was taken, the cutaneus part being large enough to cover the defect. Extensor tendons were reconstructed with free tendon transplants. Flap healing was uneventful.

Amputation is usually indicated in these cases. To the best of the authors' knowledge, microsurgical reconstruction in infants this age with congenital malignant tumors has not yet been reported. The case demonstrates that plastic surgery can play an important role in pediatric oncology and should routinely be integrated into multi-modality treatment concepts.