Infiltrative Squamocellular Carcinoma of the Forearm in a Patient with Uncontrolled Psoriasis: Impact on Microsurgical Flap Viability and Microcirculation

Psoriasis vulgaris incidence in Italy is 2%-3%, 0.1% with severe forms with systemic erythema, risk of skin cancer, and hypercoagulation disorders. These patients are a challenging cohort for free-tissue transfer reconstructions. We present a 47-year-old woman with a history of generalized uncontrolled pustular psoriasis with an infiltrative squamocellular carcinoma of the forearm of 5 cm x 3 cm. We offered a reconstructive approach with vascularized fibular intercalary reconstruction of the ulna and a combined anterolateral thigh flap for the soft-tissue defect. The surgical outcome was complicated by incoercible vasospasm, arterial thrombosis, and free-flap failure. We decided to review the literature and formulate a therapeutic protocol to tackle the critical aspects of psoriasis impacting on free-flap viability before reintervention. Eventually, the outcome was successful. No article was available putting in relation to these two aspects. We believe this is the first article of its kind and would be a starting point for further studies.