A 50-year-old female diagnosed with B-cell non-Hodgkin lymphoma undergoing chemotherapy with rituximab, cyclophosphamide, vincristine, doxorubicin and high-dosage prednisone was presented to our department with a massive and painful swelling in the cubital area of her left arm after an extravasate with doxorubicin. As an initial surgical treatment, we incised the wound following local debridement. Within 7 days of appropriate treatment with daily wound lavage and antibiotic therapy, the affected wound area impressed with nearly complete necrosis. Therefore, necrectomy of the necrotic tissue was performed revealing a tissue defect of the complete proximal third of the left palmar forearm. After a prolonged hospitalization coupled with several repetitive debridements, antibiotic therapy, as well as the immobilization of the left arm in a cast, the wound finally appeared vital and surgically clean. We decided to close the wound by performing a free parascapular flap to the left forearm (Figure 1 ). Perioperatively, the patient received her regular prednisone dosage plus an extra-dosage during surgery. Both the flap and the wound healing were monitored carefully. After 5 days, a small dehiscence with serous outflow on the proximal wound occurred. After daily lavage and alginate wound dressing commenced, the wound healing was uncomplicated and finally, the patient could be discharged after a hospitalization period of nearly 10 weeks.
A 72-year-old woman with the initial diagnosis of a malignant melanoma on the right lower leg presented to our clinic after an in sano excision in a clinic alio loco. However, after further excision of the melanoma, we closed the wound using skin mesh-graft. After complete wound healing, the patient received a low-dose interferon therapy with Roferon. After 3 months, the patients presented to us with worsening of the wound condition and a reappearance of activated melanoma in situ of the scar on the right lower leg. Therefore, a radical excision of the pretibial scar and a temporary covering with alloplastic material was performed. After several debridements, a clean granulating wound could be achieved making it possible to cover the defect of the lower leg with a free radial forearm flap from the right forearm. Finally, the patient could be discharged with normal wound healing from our department and received further chemotherapy without any sign of re-appearance of the malignant melanoma so far.