Modified fasciocutaneous and muscle flap from medial head of gastrocnemius muscle for anterior tibial soft-tissue defects after resection of sarcoma

Introduction. Treatment of soft-tissue and osteo-sarcomas requires close cooperation between an oncologist and a surgeon since it is a combined therapy. Five-year survival rate has been constantly increasing recently despite the fact that the number of amputations has been limited significantly in favour of limb salvage surgery. However, permanent and effective reconstruction of bone and soft-tissue defects is still problematic. Description of a case. A 83-year-old man was admitted to our hospital for malignant fibrous histiocytoma (MFH) of the tibial bone. The patient was diagnosed with soft tissue sarcoma elsewhere before he was hospitalised in our clinic. The patient underwent four surgeries. After imaging examinations including x-ray of the tibia and MRI scans we opted for conservative treatment i.e. limb salvage surgery. The tumour together with soft tissue surrounding it was removed. The tibial bone was reconstructed using an intramedullary rod and bone cement. Softtissue defect was covered with fasciocutaneous and muscle flap from the medial head of gastrocnemius muscle. The flap was modified i.e. muscle part was separated from fasciocutaneous flap in its distal part in order to achieve better coverage of the defect. The wound healed without any complications. Discussion. Malignant fibrous histiocytoma (MFH) belongs to the group of sarcomas originating from soft tissues as well as bones. Diagnostic procedures must include imaging examinations of bones. Limb salvage surgery is much more complicated than amputation and it always is connected with tissue reconstruction. Bones are usually reconstructed with intramedullary rods, prosthetic material, bone cement or allograft bones. Soft tissue reconstruction must preserve vascularisation and innervation of the operated area. Therefore, the surgeon must have thorough knowledge about vascular and nerve supply. Anterior tibial tissue defects comprise a very difficult challenge since the adherence of cutaneous layers to the tibial bone. Vascularised fasciocutaneous and muscle flap is a good solution in this case. Conclusions. Malignant fibrous histiocytoma (MFH) is sarcoma of soft-tissues and bones. Limb salvage surgery requires complicated reconstruction techniques for soft-tissue and bone defects. Fasciocutaneous and muscle flap is a good therapeutic option for anterior surface defects of the tibia, however its application requires thorough knowledge about vascularisation and innervation of muscles and the skin.