Management of two rare cases of dermatofibrosarcoma protuberans arising in the parotid region

Abstract

Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous tumour, accounting for less than 1% of malignant tumours of the head and neck region. This tumour rarely presents metastatic disease, but has a high recurrence rate. Therefore, wide surgical excision with microscopically free margins is the therapeutic gold standard. Only five cases are described in literature of this tumour arising in the parotid region, a site that presents challenges both in achieving a wide demolition and in reconstructing the resulting defect. Here we describe two cases of DFSP arising in the parotid region that were treated surgically, achieving microscopically free margins. Reconstruction of the vast skin defect was achieved by means of a supraclavicular artery island flap, with good functional and aesthetic results.

Reconstruction options in recurrent dermatofibrosarcoma protuberans:A scoping review

“… 21 A supraclavicular artery island flap was used to reconstruct a defect in the parotid region with good results as this achieves microscopic free margins and good aesthetic results with better colour matches. 22 Two patients underwent wide resection of forehead DFSP and reconstruction with a single rotational scalp flap based on the blood supply territories involving 3 major vessels namely occipital, superficial temporal, and posterior auricular artery. A free latissimus dorsi flap was done in stages to close an abdominal defect in this study with a 5cm margin and achieve a deeper resection for a disease-free result.…”

Use of platelet-rich plasma in irradiated patients to treat and prevent complications of head and neck surgery

“…It is well demonstrated that preoperative RT, as well as other risk factors mentioned above, increases the risk of postsurgical complications, such as wound dehiscences and fistulas, as irradiated tissues are chronically hypoxic, hypocellular and hypoperfused, making it more difficult for surgical wounds to heal 3. One strategy that has been widely used in order to prevent complications in these patients is the implementation of free or pedicled flaps 4…”

Head and neck pedicled flap autonomization using a new high‐resolution indocyanine green fluorescence video‐angiography device

“…Head and neck tumors often need a reconstructive phase with pedicled or free flaps after the ablative surgery 1–6 . Some pedicled flaps, such as the supraclavicular flap or the paramedian forehead flap (PFF), may require a second‐stage pedicle division and inset after the initial harvesting, a procedure consisting of pedicle division generally performed at least 3 weeks after the former one to let flap inosculation occur 7 …”

“…Head and neck tumors often need a reconstructive phase with pedicled or free flaps after the ablative surgery. [1][2][3][4][5][6] Some pedicled flaps, such as the supraclavicular flap or the paramedian forehead flap (PFF), may require a second-stage pedicle division and inset after the initial harvesting, a procedure consisting of pedicle division generally performed at least 3 weeks after the former one to let flap inosculation occur. 7 Several techniques are commonly used for perfusion assessment of the flaps, including simple visual observation, Doppler ultrasound, tissue oximetry, and indocyanine green (ICG) fluorescence video-angiography.…”