Malignant Peripheral Nerve Sheath Tumor of the Hand

Abstract

Sir: The popliteal fossa defect is a rare and difficult-to-treat condition. The great mobility and the proximity to important lower extremity vessels are aspects to consider. Diverse techniques have been described to treat this defect, such as muscle flaps,1 fasciocutaneous flaps,2 free flaps,3 split-thickness grafts, allografts, and expanders,4 with these last ones being used most frequently for burns and trauma sequelae. There are few techniques that provide primary closure of this area; rotation flaps are a good option that give good-quality scars. The purpose of this article is to report our experience with closure of popliteal fossa defects using the fasciocutaneous cone flap that we had described previously.5 Clinical data were obtained from patients with unique or associated popliteal fossa defects who underwent reconstruction with a fasciocutaneous cone flap at the Hospital del Trabajador in Santiago, Chile, between 2000 and 2007. There were five patients included in the study, all of whom were men with a mean age of 37.4 years (range, 26 to 47 years). The injury mechanism was trauma: two vehicle accident injuries, two work-related injuries, and one sports-related injury. The mean defect length was 11.6 cm (range, 8 to 20 cm), compromising deep structures. Two of them had associated vascular injury. All patients underwent reconstruction with a fasciocutaneous cone flap, which consists of a rotation flap covering the defect and a V-Y advancement flap toward the donor area. The patients with vascular compromise required a previous vessel repair. There were three dehiscences in the proximal portion of the rotation flap that required resuture. The patients were discharged at a mean of 24.2 days (range, 8 to 38 days) after the fasciocutaneous cone flap operation. There are few publications concerning the coverage of popliteal fossa defects. Our results using the fasciocutaneous cone flap have solved this problem, with acceptable complications. The cone flap provided a good-quality coverage that allowed normal functionality of the lower limb in the long term. The importance of this report is to present an alternative for the closure of popliteal fossa defects in only one operation, with excellent functional and aesthetic results (Figs. 1 through 3).Fig. 1.: Popliteal defect measuring 15 × 8 cm.Fig. 2.: Repair with the fasciocutaneous cone flap.Fig. 3.: Final result.Wilfredo Calderón, F.A.C.S. Sergio Llanos, M.D. Rodrigo Villagrán, M.D. Rocío Las Heras, M.D. Daniel Calderón Burns and Plastic Surgery Department Hospital del Trabajador de Santiago Santiago, Chile