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Recurrent abdominal wall dermatofibrosarcoma protuberans in a child: a challenging reconstruction.

Vallam KC, Bhagat M, Shankhdhar V, Qureshi SS - Springerplus (2015)

Bottom Line: Dermatofibrosarcoma protuberans is an uncommon low-grade soft tissue sarcoma with a high potential for recurrence as it has irregular finger like extensions.Large composite defect, involving more than half of the anterior abdominal wall, necessitate a free flap reconstruction.Complete surgical excision is essential for DFSP of the abdominal wall, which may result in large challenging defects.

View Article: PubMed Central - PubMed

Affiliation: Division of Pediatric Surgical Oncology, Department of Surgical Oncology, Tata Memorial Centre, Ernest Borges Road, Parel, Bombay, 400012 India.

ABSTRACT

Introduction: Dermatofibrosarcoma protuberans is an uncommon low-grade soft tissue sarcoma with a high potential for recurrence as it has irregular finger like extensions.

Case description: We report a case of a large, recurrent dermatofibrosarcoma protuberans in a child involving the anterior abdominal wall, which posed a challenge for reconstruction. Peritoneum sparing full thickness resection of the anterior abdominal wall, meshplasty and a free anterolateral thigh flap was performed for reconstruction of the defect.

Discussion and evaluation: Large composite defect, involving more than half of the anterior abdominal wall, necessitate a free flap reconstruction. Although these reconstructions are technically challenging in children, they are the only option available.

Conclusion: Complete surgical excision is essential for DFSP of the abdominal wall, which may result in large challenging defects. Free flaps remain the only option in this scenario and hence it is essential to have expertise for microvascular flap reconstruction.

No MeSH data available.


Related in: MedlinePlus

Harvested free anterolateral thigh flap.
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Fig8: Harvested free anterolateral thigh flap.

Mentions: Core needle biopsy was suggestive of DFSP. Surgical excision was planned with a wide margin of 2 cm and excising the entire rectus sheath (both anterior and posterior layers along with the muscles). The skin with the linear scar, hatch marks and the drain site scar were included in the resection (Figure 3). Since there was no intra-abdominal extension, the peritoneum was left intact except at one place where the tumor was abutting it (Figures 4, 5). Due to the sparse underlying omentum, placement of intraperitoneal mesh was deferred. The peritoneum was mobilized all around until the lateral abdominal wall and a primary closure of peritoneum was achieved (Figure 6). A pre-peritoneal VYPRO® mesh was placed and anchored to the peritoneum (Figure 7). A free anterolateral thigh flap was harvested from the thigh and microvascular anastamosis was performed between the flap vasculature (cutaneous perforators of the descending branch of the lateral femoral circumflex vessels) and the deep inferior epigastric vessels (Figure 8). The deep fascia of the flap was sutured to the rectus sheath and skin approximated (Figure 9).Figure 3


Recurrent abdominal wall dermatofibrosarcoma protuberans in a child: a challenging reconstruction.

Vallam KC, Bhagat M, Shankhdhar V, Qureshi SS - Springerplus (2015)

Harvested free anterolateral thigh flap.
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4495091&req=5

Fig8: Harvested free anterolateral thigh flap.
Mentions: Core needle biopsy was suggestive of DFSP. Surgical excision was planned with a wide margin of 2 cm and excising the entire rectus sheath (both anterior and posterior layers along with the muscles). The skin with the linear scar, hatch marks and the drain site scar were included in the resection (Figure 3). Since there was no intra-abdominal extension, the peritoneum was left intact except at one place where the tumor was abutting it (Figures 4, 5). Due to the sparse underlying omentum, placement of intraperitoneal mesh was deferred. The peritoneum was mobilized all around until the lateral abdominal wall and a primary closure of peritoneum was achieved (Figure 6). A pre-peritoneal VYPRO® mesh was placed and anchored to the peritoneum (Figure 7). A free anterolateral thigh flap was harvested from the thigh and microvascular anastamosis was performed between the flap vasculature (cutaneous perforators of the descending branch of the lateral femoral circumflex vessels) and the deep inferior epigastric vessels (Figure 8). The deep fascia of the flap was sutured to the rectus sheath and skin approximated (Figure 9).Figure 3

Bottom Line: Dermatofibrosarcoma protuberans is an uncommon low-grade soft tissue sarcoma with a high potential for recurrence as it has irregular finger like extensions.Large composite defect, involving more than half of the anterior abdominal wall, necessitate a free flap reconstruction.Complete surgical excision is essential for DFSP of the abdominal wall, which may result in large challenging defects.

View Article: PubMed Central - PubMed

Affiliation: Division of Pediatric Surgical Oncology, Department of Surgical Oncology, Tata Memorial Centre, Ernest Borges Road, Parel, Bombay, 400012 India.

ABSTRACT

Introduction: Dermatofibrosarcoma protuberans is an uncommon low-grade soft tissue sarcoma with a high potential for recurrence as it has irregular finger like extensions.

Case description: We report a case of a large, recurrent dermatofibrosarcoma protuberans in a child involving the anterior abdominal wall, which posed a challenge for reconstruction. Peritoneum sparing full thickness resection of the anterior abdominal wall, meshplasty and a free anterolateral thigh flap was performed for reconstruction of the defect.

Discussion and evaluation: Large composite defect, involving more than half of the anterior abdominal wall, necessitate a free flap reconstruction. Although these reconstructions are technically challenging in children, they are the only option available.

Conclusion: Complete surgical excision is essential for DFSP of the abdominal wall, which may result in large challenging defects. Free flaps remain the only option in this scenario and hence it is essential to have expertise for microvascular flap reconstruction.

No MeSH data available.


Related in: MedlinePlus