Surgical treatment of multiple deforming xanthomas of the foot and ankle with complete excision and rotational skin flaps: A case report

• Published in: Foot & ankle surgery (New York, N.Y.) N.Y.), 2022, Vol.2 (2), p.100173, Article 100173
• Main Authors: Ali, Qanita, Randall, Rachelle, Fallat, Lawrence M.
• Format: Article
• Language: English
• Subjects: 5 Classification Rearfoot and Ankle Reconstruction; Hyperlipidemia; Podiatric surgery; Reconstructive surgery; Rotational flap; Skin flap; Skin plasty; Xanthoma
• ISSN: 2667-3967; 2667-3967
• DOI: 10.1016/j.fastrc.2022.100173

Xanthomas are cholesterol rich nodular dermal lesions characterized by lipid-laden macrophages that accumulate in skin and tendons.1 These lesions are frequently associated with hyperlipidemia disorders characterized by impaired cholesterol metabolism and accelerated atherosclerotic plaque development.2 Until recently, xanthomas were considered mere cosmetic lesions, however extensive evidence has shown that the presence of xanthomas signify increased cardiovascular risk and reduced average lifespan.3 Treatment centers around lipid lowering agents and rarely are these masses large enough to require surgical resection, thus there is very little literature discussing proper surgical excision.4,5 We present a rare case of a 65 year old female with multiple painful deforming xanthoma masses large enough to cause an inability to fit into shoe gear, ambulate, or dorsiflex her ankle joints. Due to the size of these masses, excision of the lesions would result in large skin deficits and the presence of multiple wounds often requiring staged excisions with application of skin grafts and wound VACs. Our report demonstrates a rare and unusual case of large deforming xanthomas in the foot and ankle successfully treated with complete surgical excision during a single procedure.