Resurfacing the defect from wide excision of a malignant peripheral nerve sheath tumor based on a thoracodorsal artery perforator free flap: a case report

Malignant peripheral nerve sheath tumors (MPNSTs) are rare, aggressive soft tissue sarcomas with a high rate of recurrence and metastasis. Limb salvage surgery with free flap reconstruction is a viable option for selected patients with MPNSTs, but careful consideration should be given to the risk of recurrence. This case report describes a 26-year-old male patient with a recurrent, aggressive, high-grade MPNST who underwent limb salvage surgery with thoracodorsal artery perforator free flap reconstruction. Despite the surgical intervention, local recurrence of the MPNST was detected, and below-knee amputation was ultimately recommended. This case highlights the importance of early, definitive treatment decision-making in cases of aggressive, high-grade MPNSTs. Close postoperative monitoring and early detection of recurrence are crucial for achieving optimal outcomes in patients with MPNSTs undergoing limb salvage surgery with free flap reconstruction.