• Ching-Yen Huang, Zhoa-Yu Hsieh, Ke-Chung Chang, and Dun-Hao Chang.
• Division of Plastic and Reconstructive Surgery, Department of Surgery, Far Eastern Memorial Hosptial, New Taipei, Taiwan.
• Medicine (Baltimore). 2023 Mar 31; 102 (13): e33450e33450.

RationaleMarjolin's ulcer (MU) is a rare skin malignancy derived from a chronic wound. Pressure ulcer related MU possesses poor prognosis and high metastatic rate, and it is difficult to be differentiated, especially when superimposed infection.Patient ConcernsHere we report a case with pressure ulcer related MU which presented as necrotizing soft tissue infection (NSTI) to demonstrate the manifestation, treatment, and prognosis of this rare disease.DiagnosesA 45-year-old male patient had spinal cord injury at age 2 years. He presented ischial pressure sore complicated with NSTI initially. After serial debridements and antibiotic treatment, the infection subsided. For the persistent verruca-like skin lesion, he underwent wide excision which revealed well-differentiated squamous cell carcinoma. Further image studies showed localized residual tumor without distant metastasis.InterventionsHe then underwent hip disarticulation and anterior thigh fillet flap reconstruction. Local recurrence developed 3 months later, and re-wide excision and inguinal lymph node dissection were performed. No lymph node metastasis was noted and adjuvant radiotherapy was given.OutcomesHe was followed for 34 months and no recurrence or metastasis was found. The patient can move with a wheelchair or a hip prosthesis, and is partially dependent for daily activities.LessonsMU can masquerade as NSTI and one should be alert to its malignant potential. Due to its aggressive nature, limb sacrifice can be considered in circumstances of profound involvement. As for the reconstruction method, pedicled fillet flap provided good wound coverage.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

25 keywords...

hide…