PMC9122378_01
Images prior to reoperation. (A) MRI T1 weighted image. (B) MRI T1 weighted image with gadolinium enhancement. The dotted line indicates the extent of tumor resection. MRI: Magnetic resonance imaging.
ICRP_A_2076683_F0001_C.jpg
PMC9122378_01_ICRP_A_2076683_F0001_C.jpg
F0001
One year later, the tumor recurred, and the patient underwent a second surgery after neoadjuvant therapy with chemotherapy and radiotherapy (Figure 1).
Intraoperative photographs of the patient in Case 1. (A) After extensive resection of the tumor, a large soft tissue defect, which exposed the radius, was observed. (B) While preserving the radial nerve, a 19 x 6.5 cm reverse lateral upper arm flap was raised. (C) The radius was covered with a flap, and a mesh skin graft was performed on a portion of the skin where the forearm muscle was exposed.
ICRP_A_2076683_F0002_C.jpg
PMC9122378_01_ICRP_A_2076683_F0002_C.jpg
F0002
A 19 x 6.5 cm reverse lateral upper arm flap was implanted for extensive soft tissue defects (Figure 2).
Case 1: Range of motion in the forearm and elbow 8 years and 3 months after the operation. (A) Degree of extension. (B) Degree of flexion.
ICRP_A_2076683_F0003_C.jpg
PMC9122378_01_ICRP_A_2076683_F0003_C.jpg
F0003
Eight years and three months postoperatively, the extension of the elbow was 0 , flexion was 140 , and International Society of Limb Salvage score was 27 points, which indicated adequate function preservation in the elbow and forearm (Figure 3).
PMC9122378_02
Radiographs of the patient in Case 2. (A) Radiograph taken immediately after the injury. The arm and elbow were contaminated with several windshield pieces. (B) Radiograph taken after debridement. The white arrow indicates deficient humeral condyles, while the black arrow indicates radial head defects.
ICRP_A_2076683_F0004_C.jpg
PMC9122378_02_ICRP_A_2076683_F0004_C.jpg
F0004
Figure 4 shows an X-ray image obtained at the time of the injury.
Intraoperative photographs of the patient in Case 2. (A) A 20 x 7 cm reverse lateral upper arm flap was designed. (B) The donor site was closed primarily. (C) One year and 5 months after flap implantation.
ICRP_A_2076683_F0005_C.jpg
PMC9122378_02_ICRP_A_2076683_F0005_C.jpg
F0005
Two days after the injury, the extensive soft tissue defects were covered with a 20 x 7 cm reverse lateral upper arm flap (Figure 5).
PMC9122378_03
Intraoperative photographs of the patient in Case 3. (A) A 17 x 7 cm reverse lateral upper arm flap was designed. (B) The forearm and the elbow at the time of primary closure of the donor site. (C) Five months after flap implantation.
ICRP_A_2076683_F0006_C.jpg
PMC9122378_03_ICRP_A_2076683_F0006_C.jpg
F0006
A 17 x 7 cm reverse lateral upper arm flap was implanted for the extensive soft tissue defects (Figure 6(a)). The donor site was temporarily sutured (Figure 6(b)); however, after suturing, the pulsation of the radial artery disappeared, and all fingers turned pale. Five months after the surgery, the healing process was uneventful (Figure 6(c)).