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Introduction: Complex chest wall reconstruction after an oncological resection requires a multidisciplinary approach with the aim of curative resection. Aim: The complexity of such reconstruction is challenged by prior reconstructions that limit the options for free tissue transfer and recipient vessels for microsurgical anastomoses. Case study: We present a case of an immunocompromised patient with prior breast reconstruction for left breast carcinoma with a pedicled lattisimus dorsi flap who presents with a recurrence to the latissimus dorsi flap requiring a more extensive oncological resection. Results and discussion: This resulted in a large chest wall defect that is re-constructed with plating and an anterolateral thigh fasciocutaneous free flap for soft tissue coverage. Conclusions: The radical resection allows for excellent overall survival and better quality of life. [ABSTRACT FROM AUTHOR]

Perivascular epithelioid cell tumors (PEComas) are a family of rare mesenchymal tumors with discrete histological and immunohistochemical characteristics. Even rarer among them are cutaneous and subcutaneous PEComas. We describe a 34-year-old woman who presented with a large anterior abdominal subcutaneous lesion showing intact overlying skin and no obvious invasion of the abdominal musculature. A wide local excision was performed. Histopathology revealed a solitary tumor measuring 75 x 55 x 90 mm with epithelioid cells in nests with thin fibrovascular septa and spindle cells. Resection margins were clear with no invasion to the skin or rectus sheath. Tumor cells were positive for HMB-45 but negative for other markers. This is the largest subcutaneous PEComa reported to date. [ABSTRACT FROM AUTHOR]