Summary: Unplanned excision of soft tissue sarcoma presents a significant clinical challenge, frequently necessitating wide re-excision that results in complex soft tissue defects. Reconstructing these defects, particularly in the extremities, often requires invasive procedures such as free flaps. This report describes the case of a 40-year-old woman with a myxoid liposarcoma of the thigh. After an initial unplanned transverse excision, a wide re-excision was performed, creating a cross-shaped defect that posed a reconstructive challenge. To reconstruct this defect, we used a pinwheel flap, a 4-flap rotation technique traditionally applied for scalp reconstruction. The selection of this method was based on the geometric coincidence between the iatrogenic defect and the flap design. The reconstruction was performed successfully, with all flaps remaining viable and leading to an uneventful postoperative recovery. At the 2-year follow-up, the patient demonstrated full ambulation, no evidence of tumor recurrence, and a satisfactory aesthetic result. To our knowledge, this is the first reported application of the pinwheel flap in the lower extremity. This case suggests that the pinwheel flap is a simple and viable reconstructive option for the specific cross-shaped defects arising from the re-excision of soft tissue sarcoma.
Inafuku et al. (Wed,) studied this question.