Advanced limb salvage reconstruction following complicated myxoid liposarcoma resection using hybrid gastrocnemius flap and sub-flap irrigating vacuum assisted closure therapy: a case report.

Myxoid liposarcoma is a malignant soft-tissue sarcoma with a high risk of local recurrence. Repeated surgery and adjuvant treatment may compromise soft tissues and therefore predispose patients to chronic infection, creating challenges for limb salvage. We report a case of recurrent myxoid liposarcoma complicated by chronic surgical-site infection that was successfully managed using gastrocnemius flap reconstruction combined with sub-flap irrigating vacuum-assisted closure therapy. A 33-year-old man presented with recurrent myxoid liposarcoma of the posterior left knee following multiple previous excisions, and chemotherapy. Tumor resection was done, along with chemotherapy and radiotherapy. After tumor resection, he developed wound dehiscence and deep surgical-site infection requiring serial debridement. Because of persistent infection and extensive soft-tissue loss, reconstruction was performed using a medial head gastrocnemius muscle flap. A sub-flap irrigating VAC system with continuous gentamicin-saline irrigation was applied to improve infection control and support flap viability. Wound cultures grew Acinetobacter baumannii, and antibiotic therapy was adjusted according to sensitivity testing. Split-thickness skin grafting was subsequently performed. At one-year follow-up, successful limb salvage was achieved without recurrent infection with complete defect coverage. This case suggests that combining gastrocnemius flap reconstruction with sub-flap irrigating VAC therapy may provide effective infection control and durable soft-tissue reconstruction in complex limb-salvage procedures.