An Integrated Surgical Management for Giant Dermatofibrosarcoma Protuberans of Anterior Abdominal Wall

Abstract

Giant dermatofibrosarcoma protuberans (DFSP) is a very rare dermal sarcoma whose diagnosis and management are important because of the high local recurrence but low metastatic potential. Complete surgical excision of giant DFSP in a single stage is difficult but has a high cure rate. A 47-year-old man presented with a gradually increasing large (18 x 15 x 7 cm) DFSP in the epigastrium. A 3 cm circumferential wide local excision (WLE) with microscopic tumor-free margin confirmed by frozen section was performed. Immediate single staged tension-free primary closure of resultant defect was done on the principle of abdominal wall reconstruction (AWR) in ventral hernia repair. This technique of anterior component separation and bridge meshplasty is functional, avoids multiple surgeries, is cost-effective, and can be done in a resource-limited setting in developing countries. A multidisciplinary and integrated surgical approach to treat giant DFSP over epigastrium, by three-dimensional WLE and immediate AWR with anterior component separation technique (CST) and bridging meshplasty, can be of immense help in managing such rare cases in developing countries.

Reconstruction options in recurrent dermatofibrosarcoma protuberans:A scoping review

“…A midline abdominal wall reconstruction with anterior component separation technique was done with bridge mesh plasty in a case of epigastric DFSP. 25 , 26 13 patients underwent wide excisions in this review. 26 , 27 Post-excision reconstruction showed direct closure in three cases, skin grafting in three cases, and local or free flap reconstruction in seven cases.…”

“…25,26 13 patients underwent wide excisions in this review. 26,27 Post-excision reconstruction showed direct closure in three cases, skin grafting in three cases, and local or free flap reconstruction in seven cases. 28 Seventeen patients (10 1 male; mean age, 9.9 years) were managed during the study period.…”