PMC3385388_01
(a) Fibrosarcoma of right shoulder, (b) surgical defect, (c) forearm flap raised from amputated limb, and (d) compromised reperfusion of flap despite anastomotic patency
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F1
She represented several months later with a tumour that was significantly larger, with lung metastases, and in constant pain [Figure 1a]. It was not possible to close the surgical defect despite mobilizing the surrounding skin [Figure 1b]. A skin flap was raised from the forearm based on the brachial vessels [Figure 1c]. The flap appeared purple in colour despite the patency of the anastamoses [Figure 1d].
PMC3385388_02
(a) Epitheloid sarcoma of pelvis, (b) flap raised from lower leg, (c) flap inset, (d) no donor site morbidity, and (e) what better assessment of outcome could there be? A smiling face is worth more than all objective scoring schemes
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F2
This 37-year-old female had suffered from epitheloid sarcoma of her pelvis for 10 years [Figure 2a]. The lower leg was disease-free [Figure 2b] and it was possible to raise a composite soft tissue flap based on the popliteal vessels. This gave both closure and padding [Figure 2c] and no donor site morbidity [Figure 2d]. She expressed no regret at her surgery and counselled other patients who were contemplating similar procedures [Figure 2e].
PMC3385388_03
(a) A fungating tumour with a terrible smell, (b) excision and closure with local flap, (c) the lesion enveloped the subclavian vessels and the branchial plexus. This was an aggressive cancer, (d) the patient is shown in the outpatient clinic 6 weeks postamputation. She remains disease free one year later
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F3
A 55-year-old lady presented with a fungating central chest mass [Figure 3a]. The chest lesion was excised together with the lower end of the sternum and the defect closed with a local flap [Figure 3b]. A CT showed a large mass compressing the left axillary artery, involving the brachial plexus and encroaching on the chest wall [Figure 3c]. She made an uneventful recovery and remains disease free and asymptomatic 1 year later [Figure 3d].