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Synoviosarcoma of arm in 4-month-old infant reconstructed with sensate free anterolateral thigh flap

A 4‐month‐old infant was brought with complaints of rapidly growing swelling in the right arm with ulceration and bleeding for 35 days [Figure 1]. There was no history of any comorbid illness. No other relevant history was elicitable. Clinical examination revealed an active infant with normal nutrition. There was a firm ovoid swelling measuring 4.5 cm × 3 cm × 3 cm attached to biceps brachii muscle with 2 cm × 3 cm ulceration at its summit, which was bleeding on manipulation [Figure 1]. There were no regional lymph node enlargements. Incisional biopsy was reported as synovial sarcoma. Metastatic workup revealed no spread of tumour to distant sites. Appropriate informed consent for the surgery was obtained from the parents including consent for the use of clinical data and pictures for research studies. The surgical oncologists under general anaesthesia did wide local excision of the tumour with 2.5‐cm margin. Resultant defect was measuring 8 cm × 6 cm. There was only small residuum of the long head of biceps with exposure of radial nerve and musculocutaneous nerve over the brachialis muscle in the bed of the excised defect [Figure 2].