Unit of Reconstructive and Plastic Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti di Foggia, 71122, Foggia, Italy.
J Med Case Rep. 2021 Apr 20;15(1):180. doi: 10.1186/s13256-021-02787-5.
Dermatofibrosarcoma protuberans (DFSP) is a rare skin fibroblastic tumor, with a high rate of recurrence. The treatment of DFSP is generally surgical, and wide local excision is the mainstay of surgical treatment. Therefore, complete assessment of all surgical margins is fundamental before definitive reconstruction. The reconstruction is a challenge for plastic surgeons, especially in particular anatomical areas (for aesthetic or functional problems) or in patients who are not candidates for more complex surgical treatments. We describe an alternative approach for reconstructive treatment of the lumbar area after wide excision of DFSP (without fresh-frozen sections) in a young obese woman with a history of smoking, using a new type of acellular dermal matrix (ADM) in a combined management protocol. The benefits of ADM are numerous: immediate wound closure and prevention of infections and excessive drying; minimal donor site morbidity; and good functional and aesthetic outcomes. Moreover, it is a temporary cover while the anatomical specimen is histologically analyzed, without donor site morbidity or prevention of any future surgery (if the margins are not tumor-free) or radiotherapy.
In October 2019, a 34-year old obese Caucasian Woman with a history of smoking came to our institute for a multinodular growing polypoid mass in her lumbar region. An incisional biopsy diagnosed DFSP. The patient underwent proper staging. A wide local excision with 3 cm clinically healthy tissue margins down to the muscle fascia was performed and the defect was repaired using a combined approach with a new artificial bilaminar dermal template (Pelnac®, Gunze Ltd., Osaka, Japan) and a negative-pressure wound therapy system (V.A.C.®, KCI, San Antonio, USA). After the final histological examination revealed tumor-free margins, a split-thickness graft was harvested from the right gluteus and fixed to the new derma with negative-pressure wound therapy. Postoperative radiotherapy was not necessary. After 15 days, the wound had healed without complications, with satisfactory aesthetic outcome and with no limitation of back motion or pain. After 6 months of follow-up, the patient was free from disease.
This is the first reported case of Pelnac® use in DFSP reconstruction of the lumbar region. We believe that the multistep approach described herein may be a good alternative approach in selected patients with wide resections in particular anatomical areas, especially when frozen sections (with Mohs micrographic surgery) are not available.
隆突性皮肤纤维肉瘤（DFSP）是一种罕见的皮肤成纤维细胞肿瘤，复发率高。DFSP 的治疗一般为手术，广泛局部切除是手术治疗的基础。因此，在进行确定性重建之前，对所有手术切缘进行全面评估至关重要。对于整形外科医生来说，重建是一个挑战，尤其是在特定的解剖区域（出于美学或功能问题）或在不适合更复杂手术治疗的患者中。我们描述了一种在有吸烟史的年轻肥胖女性中，在广泛切除 DFSP 后（无新鲜冷冻切片），使用新型去细胞真皮基质（ADM）进行重建治疗腰区的替代方法，该患者的腰区发生了 DFSP。ADM 的优点很多：可立即闭合伤口，预防感染和过度干燥；供区并发症少；且功能和美容效果良好。此外，它是组织学分析解剖标本时的临时覆盖物，不会产生供区并发症，也不会妨碍任何未来的手术（如果切缘未无肿瘤）或放疗。
2019 年 10 月，一位 34 岁的肥胖白人女性因腰部长出多结节状、息肉状肿块就诊于我院。切开活检诊断为 DFSP。患者进行了适当的分期。进行了广泛的局部切除，切除范围为 3cm 临床健康组织，直达肌肉筋膜，并采用新型人工双层真皮模板（Pelnac®，日本冈织株式会社）和负压伤口治疗系统（V.A.C.®，美国 KCI）联合修复缺损。最终的组织学检查显示切缘无肿瘤后，从右侧臀部分离取皮片，并用负压伤口治疗固定于新的真皮上。无需术后放疗。15 天后，伤口愈合，无并发症，美容效果满意，背部活动和疼痛均无受限。随访 6 个月后，患者无疾病。
这是首例报道使用 Pelnac®修复 DFSP 腰部的病例。我们认为，对于在特定解剖区域广泛切除的患者，尤其是在无法进行冰冻切片（Mohs 显微外科）的情况下，本文描述的多步骤方法可能是一种很好的替代方法。
