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. 2014 Jan 14;3(1):2047981613516614.
doi: 10.1177/2047981613516614. eCollection 2014 Jan.

Latissimus dorsi free flap reconstruction of major abdominal defect in treatment of giant Marjolin's ulcer: a short report focused on preoperative imaging

Signe Muus Steffensen  1 , Anders Thomassen  2 , Jesper Poul Naested Jensen  3 , Jens Ahm Soerensen  4
Affiliations

Latissimus dorsi free flap reconstruction of major abdominal defect in treatment of giant Marjolin's ulcer: a short report focused on preoperative imaging

Signe Muus Steffensen et al. Acta Radiol Short Rep. .

Abstract

We present a case of a 56-year-old man with a giant carcinoma in the abdominal wall. Based on positron emission tomography/computed tomography (PET/CT) scan there were FDG-avid lymph nodes in the ipsilateral axillary and groin, suspicious for metastases. At contrast-enhanced CT the parietal peritoneum seemed free of tumor invasion, which was essential to radical surgery planning. The tumor was completely removed with clear margins of resection and no metastasis in the resected lymph nodes. The PET/CT scan was repeated after 4 months, showing no signs of recurrence.

Keywords: Positron emission tomography (PET); computed tomography (CT); metastases; soft tissues/skin; surgery.

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Figures

Fig. 1.
Fig. 1.
The 56-year-old patient as he presented at the time of admission to hospital.
Fig. 2.
Fig. 2.
Preoperative PET/CT: coronal (a) and transaxial (b, c) images from PET/CT and CT demonstrating FDG-avid, marginally enlarged right axillary lymph nodes with eradicated fatty hilus, suspicious of metastases (green arrows). On left side transaxial (d, e) PET/CT and CT images demonstrated less FDG-avid lymph nodes with preserved fatty hilus, suggestive of inflammation (purple arrows).
Fig. 3.
Fig. 3.
Preoperative contrast-enhanced CT: transaxial (a) and sagittal (b) image without signs of tumor invasion into the parietal peritoneum.
Fig. 4.
Fig. 4.
Peroperative image. After resecting the tumor with a margin of 3 cm including underlying ribs and peritoneum, there was a large peritoneal defect exposing the ventricle, liver, and intestines, all macroscopically unaffected.
Fig. 5.
Fig. 5.
Two months postoperatively displaying the surviving flap on the abdomen and the donor site on the back. There was no hernia in relation to the flap. The patient was given intense physiotherapy leaving him with only minor limitations in range of motion of the right arm.
See this image and copyright information in PMC

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