From the Division of Plastic Surgery, Department of Surgery, Cathay General Hospital.
Department of General Surgery, Cathay General Hospital, Taipei City.
Ann Plast Surg. 2024 Jan 1;92(1S Suppl 1):S41-S44. doi: 10.1097/SAP.0000000000003785.
Harvesting an adequate-sized flap is challenging for reconstructing large defects on the abdominal wall. A subtotal thigh flap would be one of the choices as it provides a well-vascularized large flap with muscle components. Moreover, dermatofibrosarcoma protuberans (DFSP) is a low-grade dermal neoplasm with a high recurrence rate. There is still no consensus on the extent of resection to prevent a recurrence.
We present a case of a patient who underwent the reconstruction of a large abdominal wall defect with a subtotal thigh flap after the resection of recurrent DFSP.
A 59-year-old man killed from a recurrent huge mass in the lower abdomen with an invasion of the small intestine. His baseline characteristics and records of operations, medications, and outcomes were reviewed.
After tumor excision, a 28 × 30-cm subtotal thigh flap was harvested from his left thigh to reconstruct the abdominal defect. A microvascular anastomosis with left deep inferior epigastric vessels was made eventually. The flap was in good condition, and the donor site was covered with a split-thickness skin graft.
Subtotal thigh flap may be considered for large abdominal wall defect reconstruction as it allows good perfusion of relatively large skin paddles compared with other free flaps. Also, patients with DFSP need definite margin-free resection and close follow-up to prevent a recurrence.
在腹壁重建中，获取足够大小的皮瓣是一项挑战。股前外侧皮瓣可作为选择之一，因为它提供了一个带有肌肉成分的血供良好的大皮瓣。此外，隆突性皮肤纤维肉瘤（DFSP）是一种低度真皮肿瘤，复发率较高。对于防止复发，切除的范围仍无共识。
我们报告了一例患者，他在切除复发性 DFSP 后，采用股前外侧皮瓣的部分皮瓣重建了一个大的腹壁缺损。
一名 59 岁男性，因下腹部巨大肿块复发并侵犯小肠而死亡。回顾了他的基线特征、手术记录、用药和治疗结果。
肿瘤切除后，从他的左大腿切取了一个 28×30cm 的股前外侧皮瓣来重建腹部缺损。最终与左腹壁下深血管进行了吻合。皮瓣状况良好，供区采用中厚皮片覆盖。
与其他游离皮瓣相比，股前外侧皮瓣可用于重建大的腹壁缺损，因为它允许相对较大的皮瓣有良好的灌注。此外，DFSP 患者需要进行明确的无边界切除和密切随访，以防止复发。
