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.
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.