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 57-year-old male patient with the initial diagnosis of an advanced malignant melanoma on the left foot was operated in our department with an excision in sano of the tumor and closing of the defect by performing a free anterolateral thigh flap (ALTP). However, diagnostic lymph node biopsy was performed as well and following positive histopathology findings, a groin dissection, which was performed without complications, was necessary. The vascular femoral structures were covered by a transposition of the sartorius muscle. As a matter of fact, the patient could be discharged within five days after an uncomplicated wound healing.\nOver the course of time, chemotherapy and radiotherapy was conducted on the affected groin by the department of dermatology. Unfortunately, positive signs of lymph metastasis were detected in the groin region again, thereby requiring the necessity of another operation for the removal of all stationary lymph nodes and subcutaneous tissue. This time wound healing was prolonged due to the immunocompromised status of the patient and the impaired skin in the groin after radiotherapy. With the formation of a chronic seroma regular puncture was necessary, which led to chronic lympho-edema, recurring erysipelas and a frequent re-hospitalisation of the patient. Finally, we decided together with the patient to re-operate the radiated groin. After several debridements the defect was closed by performing loco-regional advancement flaps. The final wound healing was acceptable with only a small dehiscence and no further seroma so far. Chemotherapy was continued by the department of dermatology after the patient had been discharged.