Abstract
Study design:
Marjolin’s ulcer is a squamous cell carcinoma that develops in posttraumatic scars and chronic wounds. Suspicion of such lesions should be raised in chronic wounds demonstrating characteristic changes. We have reported the peculiar phenomenon of malignant transformation of chronic pressure sores that occurred in a paraplegic patient.
Objectives:
The aim of this study was to cover the extensive defects by a last resort reconstructive option.
Setting:
Department of Plastic and Reconstructive Surgery, Università Politecnica delle Marche, Ancona, Italy.
Methods and results:
A 40-year-old paraplegic man, with multiple hemangioblastomas of the brain and spinal cord due to Von Hippel Lindau syndrome developed pressure ulcers with unstable healing over the sacral, trochanteric, bilateral, and ischiatic areas after 15 years from neurosurgery. The biopsy result showed an invasive squamous carcinoma. Carcinomas in pressure sores are highly aggressive, and they need to be treated more radically. In our case we opted for a demolitive surgical treatment including musculocutaneous rotational flap harvested from total left thigh to cover the extensive defects. The limb was previously disarticulated.
Conclusion:
In Marjolin’s ulcer, multiple biopsies are the first-line modality for the early diagnosis as they are a safe method with high rate of accuracy. First-line treatment is surgery consisting of radical excision with lymph node dissection, if they are involved. Adjuvant radiation therapy may be used in selected patients. Management of massive pelvic defects can be a challenging problem. The pedicled lower limb flap offers a technique that can be considered as a last resort procedure for extensive defects where other options are insufficient or not available anymore. In our case the patient is disease-free after 2 years of follow-up.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Biglari b, Buchler A, Reitzel T, Swing T, Gerner HJ, Ferbert T et al. A retrospective study on flap complications after pressure ulcer surgery in spinal cord-injured patients. Spinal Cord 2014; 52: 80–83.
Yu N, Long X, Lujan-Hernandez JR, Hassan KZ, Bai M, Wang Y et al. Marjolin’s ulcer: a preventable malignancy arising from scars. World J Surg Oncol 2013; 11: 313.
Htwe O, Leow M, Naicker AS . Marjolin’s Ulcer complicating a pressure sore. Eur J Gen Med 2011; 8: 246–249.
Choi JY, Bae YC, Nam SB, Bae SH . Impact of disturbed wound healing after surgery on the prognosis of Marjolin’s Ulcer. Arch Plast Surg 2013; 40: 198–202.
Grassetti L, Scalise A, Lazzeri D, Carle F, Agostini T, Gesuita R et al. Perforator flaps in late-stage pressure sores treatment: outcome analysis of 11-year-long experience with 143 patients. Ann Plast Surg 2013 (e-pub ahead of print 12 June 2013).
Acknowledgements
AS, GDB and LG led the study design, coordination and had the role of first surgeons; MP, MF, MO and AM collected the clinical data before and after surgery; CT and EB participated in the study design and drafted the manuscript. All authors read and approved the final manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Scalise, A., Tartaglione, C., Pierangeli, M. et al. Paraplegia in a patient with Von Hippel Lindau syndrome: surgical and reconstructive treatment of Marjolin’s ulcer. A case report. Spinal Cord 52 (Suppl 3), S1–S3 (2014). https://doi.org/10.1038/sc.2014.111
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sc.2014.111
