ArticleInternational journal of surgery case reports2026
Trapezius flap for reconstruction of malignant transformation of a chronic occipital burn scar with skull involvement in a 70-year-old man: a case report.
Article in International journal of surgery case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Chronic burn scars may undergo malignant transformation into a Marjolin's ulcer, most commonly a squamous cell carcinoma. Advanced lesions involving the calvarium present significant oncologic and reconstructive challenges. Case presentation: A 70-year-old man presented with a chronic non-healing occipital ulcer that developed 2 years after a full-thickness thermal burn caused by boiling water. The injury had been managed only with repeated dressings, resulting in complete scalp alopecia and persistent ulceration. Biopsy confirmed basaloid squamous cell carcinoma, and computed tomography demonstrated occipital bone invasion without intracranial extension or distant metastasis. Wide oncologic excision of the scalp and involved calvarium was performed until healthy dura was exposed. The resulting defect was reconstructed using a pedicled lower trapezius myocutaneous flap. Histopathology confirmed basaloid squamous cell carcinoma with involvement of the deep resection margin. At a 6-month follow-up, the flap remained viable, with satisfactory wound healing and no clinical evidence of recurrence. Clinical discussion: Reconstruction of extensive posterior scalp defects with calvarial involvement is technically demanding. Although free tissue transfer is often preferred for large scalp defects, regional flaps remain valuable in elderly patients or when microsurgical reconstruction is not feasible. In this case, the pedicled lower trapezius myocutaneous flap provided reliable vascularized tissue, durable coverage of the exposed dura, and satisfactory functional and reconstructive outcomes. Conclusion: Early biopsy of chronic burn scars is essential to detect malignant transformation. The pedicled lower trapezius myocutaneous flap represents a safe and effective reconstructive option for extensive occipital scalp defects following oncologic resection with calvarial involvement.
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