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 25-year-old male with colitis ulcerosa treated with prednisone was transferred to our department with a soft tissue defect at the left neck and upper left thorax after local necrosis following an abscess due to an erroneous puncture of a central line (Figure 2a ). After several debridements, applying vacuum- and antibiotic therapy combined with continuing a low dose prednisone therapy, the wound was vital and microbiologically free of bacteria. As reconstructive surgery, we decided to perform a supraclavicular artery island flap. The postoperative wound healing process showed no signs of infection with only a minor dehiscence at the drainage area so that we could discharge the patient with a good reconstructive result (Figure 2b ).\nHowever, following the necessity of increasing the prednisone therapy due to an acute period of colitis ulcerosa, the patient presented himself again 3 weeks after being discharged with multiple dehiscence around the elevation site of the supraclavicular flap with serous outflow. The microbiological tests showed no evidence of bacteria. After multiple debridements, the secondary wound was covered with skin grafts using MatriDerm® as dermal matrix (Figure 2c, d ). The young, immunocompromised patient could finally be discharged after an overall hospitalization stay of more than 12 weeks.