PMC4582478_01
Preoperative finding
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F1
A year before the patient's physician had excised a mass without taking samples for histology (initial situation: Figure 1 (Fig. 1); preoperative state one year after first excision: Figure 2 (Fig. 2)).
Local recurrence
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F2
A year before the patient's physician had excised a mass without taking samples for histology (initial situation: Figure 1 (Fig. 1); preoperative state one year after first excision: Figure 2 (Fig. 2)).
Intraoperativ findings: involvement of the skull
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F3
After tumour excision (intraoperative situs: Figure 3 (Fig. 3)) histopathological findings showed a firm tumour involving the dermis and subcutaneous fat, consisting of basaloid epithelial cells arranged in cribriform and tubular pattern as well as some focal solid pattern.
After abrasion of the external cortical wall
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F4
The external cortical wall of the cranial bone was removed (Figure 4 (Fig. 4)).
Coverage with M. latissimus dorsi free flap
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F5
A lateral neck dissection was performed and the surgical defect (10x14 cm) was covered with a free latissimus dorsi flap (Figure 5 (Fig. 5)) with a split-thickness skin graft (postoperative result: Figure 6 (Fig. 6)).
One week and six months after surgery
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F6
A lateral neck dissection was performed and the surgical defect (10x14 cm) was covered with a free latissimus dorsi flap (Figure 5 (Fig. 5)) with a split-thickness skin graft (postoperative result: Figure 6 (Fig. 6)).