Sacral Squamous Cell Carcinoma in Psoriatic Lesion: Reconstruction by Combined Gluteal Turnover and Fasciocutaneous Flap by Naveen kumar in surgery and case studies open access journals in lupine publishers
Studies have shown incidence of 1-5 % SCC development in old psoriatic plaques out of which sacrum is rare site. In our case we excised a post psoriatic SCC and reconstructed it with a gluteus maximus turnover flap on one side along with fasciocutaneous only VY advancement flap on other side.A 45-year-old gentleman was presented with an ulceroproliferative growth on sacral region over the pre-existing lesions of psoriasis for the last 6 months. The lesions were firm to hard in consistency, fixed to underlying fascia and muscle, bone was free, there was sero-sanguineous oozing from the lesions. Histopathology was suggestive of well-differentiated squamous cell carcinoma (SCC). Lesion was excised with 2 cm margin, in depth the level of excision was till periosteum of sacrum. The true soft tissues defect was around 15 cm by 10 cm with exposed sacrum in the middle part. On right side gluteus maximum muscle only turnover flap was raised, and on left side VY faciocutaneous flap was raised to cover the defect. Patient was discharged on 10th Post-operative day.We conclude that long standing psoriatic ulcer should always be assessed for conversion into malignancy. Gluteal maximus muscle flaps can be used with various combinations with fasciocutaneous flaps for reconstruction of sacral defects.
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