A rare case of high-grade synovial sarcoma of the hindfoot

Aim: To report our personal experience in hindfoot reconstruction using an anterolateral thigh (ALT) free flap following radical resection of a high-grade synovial sarcoma. Methods The patient underwent clinical and imaging assessments, and a biopsy of the lesion confirmed the diagnosis of synovial sarcoma (SS) of the hindfoot. A multidisciplinary team was involved to define the most appropriate therapeutic strategy. Results After radical resection of the tumor mass, soft tissue coverage of the extensive skin defect was achieved using an ALT free flap. No local recurrences were observed during the follow-up period. At approximately twenty-four months after surgical treatment, the patient is able to ambulate independently, with no significant limitations in daily activities. Conclusion The complex management of this rare disease requires a dedicated reference center for foot and ankle surgery, supported by a multidisciplinary team including expert orthopedic and plastic surgeons, as well as specialized oncologists, to ensure accurate diagnosis and appropriate treatment.