Abstract
Study design: Marjolin's ulcer is a squamous cell carcinoma that develops in posttraumatic scars and chronic wounds. Suspicion of such lesions should be raised in chronic wounds demonstrating characteristic changes. We have reported the peculiar phenomenon of malignant transformation of chronic pressure sores that occurred in a paraplegic patient. Objectives: The aim of this study was to cover the extensive defects by a last resort reconstructive option. Setting: Department of Plastic and Reconstructive Surgery, Università Politecnica delle Marche, Ancona, Italy. Methods and results: A 40-year-old paraplegic man, with multiple hemangioblastomas of the brain and spinal cord due to Von Hippel Lindau syndrome developed pressure ulcers with unstable healing over the sacral, trochanteric, bilateral, and ischiatic areas after 15 years from neurosurgery. The biopsy result showed an invasive squamous carcinoma. Carcinomas in pressure sores are highly aggressive, and they need to be treated more radically. In our case we opted for a demolitive surgical treatment including musculocutaneous rotational flap harvested from total left thigh to cover the extensive defects. The limb was previously disarticulated. Conclusion: In Marjolin's ulcer, multiple biopsies are the first-line modality for the early diagnosis as they are a safe method with high rate of accuracy. First-line treatment is surgery consisting of radical excision with lymph node dissection, if they are involved. Adjuvant radiation therapy may be used in selected patients. Management of massive pelvic defects can be a challenging problem. The pedicled lower limb flap offers a technique that can be considered as a last resort procedure for extensive defects where other options are insufficient or not available anymore. In our case the patient is disease-free after 2 years of follow-up.
| Original language | English |
|---|---|
| Pages (from-to) | S1-S3 |
| Journal | Spinal Cord |
| Volume | 52 |
| DOIs | |
| Publication status | Published - 2014 |
Fingerprint
ASJC Scopus subject areas
- Clinical Neurology
- Neurology
Cite this
Paraplegia in a patient with Von Hippel Lindau syndrome : Surgical and reconstructive treatment of Marjolin's ulcer. A case report. / Scalise, A.; Tartaglione, C.; Pierangeli, M.; Bolletta, E.; Fraccalvieri, M.; Grassetti, L.; Ottonello, M.; Nicoletti, G.; Massone, A.; Di Benedetto, G.
In: Spinal Cord, Vol. 52, 2014, p. S1-S3.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Paraplegia in a patient with Von Hippel Lindau syndrome
T2 - Surgical and reconstructive treatment of Marjolin's ulcer. A case report
AU - Scalise, A.
AU - Tartaglione, C.
AU - Pierangeli, M.
AU - Bolletta, E.
AU - Fraccalvieri, M.
AU - Grassetti, L.
AU - Ottonello, M.
AU - Nicoletti, G.
AU - Massone, A.
AU - Di Benedetto, G.
PY - 2014
Y1 - 2014
N2 - Study design: Marjolin's ulcer is a squamous cell carcinoma that develops in posttraumatic scars and chronic wounds. Suspicion of such lesions should be raised in chronic wounds demonstrating characteristic changes. We have reported the peculiar phenomenon of malignant transformation of chronic pressure sores that occurred in a paraplegic patient. Objectives: The aim of this study was to cover the extensive defects by a last resort reconstructive option. Setting: Department of Plastic and Reconstructive Surgery, Università Politecnica delle Marche, Ancona, Italy. Methods and results: A 40-year-old paraplegic man, with multiple hemangioblastomas of the brain and spinal cord due to Von Hippel Lindau syndrome developed pressure ulcers with unstable healing over the sacral, trochanteric, bilateral, and ischiatic areas after 15 years from neurosurgery. The biopsy result showed an invasive squamous carcinoma. Carcinomas in pressure sores are highly aggressive, and they need to be treated more radically. In our case we opted for a demolitive surgical treatment including musculocutaneous rotational flap harvested from total left thigh to cover the extensive defects. The limb was previously disarticulated. Conclusion: In Marjolin's ulcer, multiple biopsies are the first-line modality for the early diagnosis as they are a safe method with high rate of accuracy. First-line treatment is surgery consisting of radical excision with lymph node dissection, if they are involved. Adjuvant radiation therapy may be used in selected patients. Management of massive pelvic defects can be a challenging problem. The pedicled lower limb flap offers a technique that can be considered as a last resort procedure for extensive defects where other options are insufficient or not available anymore. In our case the patient is disease-free after 2 years of follow-up.
AB - Study design: Marjolin's ulcer is a squamous cell carcinoma that develops in posttraumatic scars and chronic wounds. Suspicion of such lesions should be raised in chronic wounds demonstrating characteristic changes. We have reported the peculiar phenomenon of malignant transformation of chronic pressure sores that occurred in a paraplegic patient. Objectives: The aim of this study was to cover the extensive defects by a last resort reconstructive option. Setting: Department of Plastic and Reconstructive Surgery, Università Politecnica delle Marche, Ancona, Italy. Methods and results: A 40-year-old paraplegic man, with multiple hemangioblastomas of the brain and spinal cord due to Von Hippel Lindau syndrome developed pressure ulcers with unstable healing over the sacral, trochanteric, bilateral, and ischiatic areas after 15 years from neurosurgery. The biopsy result showed an invasive squamous carcinoma. Carcinomas in pressure sores are highly aggressive, and they need to be treated more radically. In our case we opted for a demolitive surgical treatment including musculocutaneous rotational flap harvested from total left thigh to cover the extensive defects. The limb was previously disarticulated. Conclusion: In Marjolin's ulcer, multiple biopsies are the first-line modality for the early diagnosis as they are a safe method with high rate of accuracy. First-line treatment is surgery consisting of radical excision with lymph node dissection, if they are involved. Adjuvant radiation therapy may be used in selected patients. Management of massive pelvic defects can be a challenging problem. The pedicled lower limb flap offers a technique that can be considered as a last resort procedure for extensive defects where other options are insufficient or not available anymore. In our case the patient is disease-free after 2 years of follow-up.
UR - http://www.scopus.com/inward/record.url?scp=84944443447&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84944443447&partnerID=8YFLogxK
U2 - 10.1038/sc.2014.111
DO - 10.1038/sc.2014.111
M3 - Article
AN - SCOPUS:84944443447
VL - 52
SP - S1-S3
JO - Spinal Cord
JF - Spinal Cord
SN - 1362-4393
ER -