biostudies-literatureUnknown21(1)Bota OTechnische Universität Dresden<h4>Background</h4>Extensive loss of soft tissue and bone due to neoplasia, trauma, or infection in extremities often leads to amputation.<h4>Case presentation</h4>We present the case of a 72-year-old female patient presenting with an extended cutaneous squamous cell carcinoma of the lower leg, developed on top of necrobiosis lipoidica. After achieving the R0 resection, a 26 × 20-cm soft tissue and 15-cm tibial bone defect resulted. The contralateral leg had been lost due to the same disease 18 years before. We achieved a successful reconstruction of the leg using a pedicled fibula transplantation, an extended anterolateral thigh perforator flap, and an internal fixation with plate and screws. Two years after the original surgery, the patient is relapse-free and mobile, with adequate function of the reconstructed foot.<h4>Conclusions</h4>Our case presented a unique combination of pedicled fibula transplantation and free extended ALT perforator flap to reconstruct an extensive defect after resection of a rare cSCC on top of NL. In selected cases, the boundaries of limb salvage can be pushed far beyond the current standards of treatment.World journal of surgical oncology38https://www.ebi.ac.uk/biostudies/studies/S-EPMC9901077biostudies-literatureLower leg reconstruction after resection of a squamous cell carcinoma on necrobiosis lipoidica with a pedicled fibula and an extended anterolateral thigh flap-a case report.PMC9901077Taqatqeh FMeier FDragu AFritzsche HBota OSchaser KDGarzarolli MfalseLower leg reconstruction after resection of a squamous cell carcinoma on necrobiosis lipoidica with a pedicled fibula and an extended anterolateral thigh flap-a case report.<h4>Background</h4>Extensive loss of soft tissue and bone due to neoplasia, trauma, or infection in extremities often leads to amputation.<h4>Case presentation</h4>We present the case of a 72-year-old female patient presenting with an extended cutaneous squamous cell carcinoma of the lower leg, developed on top of necrobiosis lipoidica. After achieving the R0 resection, a 26 × 20-cm soft tissue and 15-cm tibial bone defect resulted. The contralateral leg had been lost due to the same disease 18 years before. We achieved a successful reconstruction of the leg using a pedicled fibula transplantation, an extended anterolateral thigh perforator flap, and an internal fixation with plate and screws. Two years after the original surgery, the patient is relapse-free and mobile, with adequate function of the reconstructed foot.<h4>Conclusions</h4>Our case presented a unique combination of pedicled fibula transplantation and free extended ALT perforator flap to reconstruct an extensive defect after resection of a rare cSCC on top of NL. In selected cases, the boundaries of limb salvage can be pushed far beyond the current standards of treatment.2023-01-01T00:00:00Z2023 Feb2025-05-29T19:43:18.972Z2025-04-20T03:38:30.577ZS-EPMC99010773674727210.1186/s12957-023-02923-z