Yi Liu, Wan Sulaiman Wan Azman, Jimeno Zosimo Ken L
Reconstructive Sciences Unit, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia.
Plastic Reconstructive Surgery Department, Hospital Queen Elizabeth, Kota Kinabalu, Sabah, Malaysia.
J Plast Reconstr Surg. 2024 Sep 26;4(2):92-99. doi: 10.53045/jprs.2023-0060. eCollection 2025 Apr 27.
We present a case of huge recurrent spindle cell sarcoma in a 3-year-old boy's right temporoparietal scalp, which was initially misdiagnosed as a hemangioma and was primarily excised after an unsuccessful trial of oral propranolol. The tumor recurred and responded to adjuvant chemotherapy. After wide local excision with a frozen section confirming clear margins, a combination of free latissimus dorsi myocutaneous flap, scalp rotational flap, and split-thickness skin graft was used to resurface the extensive postresection defect. However, the patient experienced marginal flap necrosis postoperatively and required multiple operations to achieve adequate soft tissue coverage. His hospitalization was also prolonged because of surgical site infection over the scalp and skin graft donor sites, which required intravenous antibiotics and regular dressing changes. The patient has been disease free after discharge with no remarkable functional deficit. In our opinion, the best tool for reconstruction of extensive scalp defects is free flaps.
我们报告一例3岁男童右侧颞顶头皮巨大复发性梭形细胞肉瘤病例，该病例最初被误诊为血管瘤，在口服普萘洛尔试验失败后进行了初次切除。肿瘤复发并对辅助化疗有反应。在进行广泛局部切除并经冰冻切片确认切缘阴性后，采用背阔肌游离肌皮瓣、头皮旋转皮瓣和中厚皮片移植相结合的方法修复广泛的切除后缺损。然而，患者术后出现皮瓣边缘坏死，需要多次手术才能实现充分的软组织覆盖。由于头皮和皮肤移植供区的手术部位感染，需要静脉使用抗生素并定期更换敷料，患者住院时间也延长了。患者出院后无疾病复发，无明显功能缺陷。我们认为，修复广泛头皮缺损的最佳工具是游离皮瓣。
