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.
A 53-years-old male patient was presented to our department with a massive hand phlegmon arising from a small skin lesion a week earlier. Despite the swelling, redness and pain, necrotic areas were also present. However, due to chronic hepatitis C the patient was immunocompromised with interferon and ribavirin therapy. After performing a first debridement with necrectomy of the affected skin and soft tissue, vacuum therapy was applied. After several debridements with finally sufficient granulation, we decided to cover the defect by performing a radial forearm flap. This procedure could be successfully done after another period of vacuum therapy as the patient suffered from ascites and his general health conditions worsened due to his liver cirrhosis. The patient could finally be discharged after 7 weeks with good wound healing and recovery from the ascites.