Akademik Veri Yönetim Sistemi
16. Congress of the European Federation of Societies for Microsurgery - EFSM, Milan, İtalya, 9 - 11 Mayıs 2024, (Özet Bildiri)
Clavipectoral Dermatofibrosarcoma and Reconstruction with Free Anterolateral Thigh Flap: Case Series
S. Melenkiş1 , C.E. Yalçın1 , S.Y. Aydın1 , C.B. Sirkeci1,Ç.Yılmaz1 , A. Ercan1, A. Demiröz1 , O.Çetinkale1
1 Plastic, Reconstructive and Aesthetic Surgery, Istanbul University - Cerrahpasa Medical Faculty, Istanbul, Turkey
Background Dermatofibrosarcoma Protuberans (DFPS) is a rare, slow-growing, locally aggressive cutaneous malignancy with the potential to deeply infiltrate underlying structures.The most common sites of the tumor are the trunk, upper extremities, head and neck. It is usually seen between the ages of 20-50 years; however, it can occur at any age with no difference in prevalence between genders. Poor aesthetic and functional results are difficult to avoid using the standard approach of complete resection with negative margins followed by reconstruction. Few cases of reconstruction using different flaps have been reported. In this article, we report 2 cases in which the clavipectoral region was reconstructed using the Anterolateral Thigh Flap (ALT) after excision for DFPS. The near-perfect functional and aesthetic results may suggest that the Anterolateral Thigh Flap should be kept in mind as a priority among possible flap options after excision of DFPS in the clavipectoral region.
Materials and Methods Both patients were male, one was 25 and the other 44 years old. Anamnesis, mass localization and examination findings were quite similar in both patients.The lesions diagnosed as DFSP were localized in the right clavipectoral region. The lesions were very similar to each other. They were 3*3 and 4*4 cm in size, respectively, with very thinned skin, nodular, telangiectatic, purple, shiny, with visible borders. Incisional biopsy of the lesions, which grew slowly over a long period of time, revealed DFSP. No muscle invasion was detected on imaging and the lesions were excised with a 3 cm clear margin including the pectoral fascia. After excision, reconstruction of the defect areas was performed with a free ALT flap. A 44 year old male patient, right clavipectoral region, reconstruction image with ALT flap after excision of a mass diagnosed as DFSP. The left one is preoperative, the right one is 6 months postoperative.A 25 year old male patient, right clavipectoral region, reconstruction image with ALT flap after excision of a mass diagnosed as DFSP. Preoperative image on the left and 6 months postoperative image on the right
Results The locally aggressive course and frequent recurrence of DFSP, especially in the trunk, lead to an aggressive surgical approach in treatment. The poor cosmetic results of skin graft in deep and wide trunk defects suggest flap options. In these two cases, reconstruction with a free ALT flap after excision of DFSP lesions in the right clavipectoral region provided near perfect aesthetic and functional results.
Conculusions In cases of DFSP in the clavipectoral region, the free ALT flap may be considered as the first choice flap for reconstruction in order to obtain the best aesthetic and functional result after wide excision.