Reverse vastus lateralis musculocutaneous flap for Marjolin's ulcer over the knee joint

Abstract

Marjolin's ulcer is a rare and often aggressive cutaneous malignancy that arises in previously traumatized or chronically inflamed skin, particularly after burns. Treatment modalities of Marjolin's ulcers include wide local excision, block dissection of the regional nodes, amputation in advanced lesions of limbs, radiotherapy, and chemotherapy. Wide local excision, together with skin grafting, is usually considered appropriate in the treatment of Marjolin's ulcers. For lesions that are located at critical places skin grafting cannot be done because either the excised bed will not take the graft or skin grafting can be done but due to the unstable nature is often avoided preferring a flap cover. Defects over the knee is challenging especially when the defect is quiet large and the surrounding skin is scarred and unhealthy. In such situations neither any local fasciocutaneous flap nor muscle flap is possible, the only option left are in the form of free tissue transfer. But if this type of situation can be managed by transferring tissue from the upper part of the thigh in the form of pedicled flap then other complex reconstructions can be avoided. We describe a case of a 45-year-old male with Marjolin's ulcer over the post burn scar of right knee for 5 years duration with no regional or distant metastasis managed with wide local excision and cover with reverse vastus lateralis musculocutaneous flap. The post op outcome is uneventful with better patient satisfaction.