Yasmine Fertani, Bouhani Malek, Naceur Radhi Ben, Olfa Jaidane, Sahraoui Ghada, Jalel Ziadi, Jamel Ben Hassouna, Tarek Ben Dhiab
Surgical Oncology Department; Salah Azaiz Institute of Oncology, Tunis, Tunisia.
Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.
World J Surg Oncol. 2025 Aug 28;23(1):327. doi: 10.1186/s12957-025-03837-8.
Sarcomas of the trunk and abdominal wall are rare and present unique challenges in both resection with free margins and reconstruction, particularly when the tissue loss is extensive. These tumors predominantly affect young, active individuals, posing a significant challenge for oncologists and plastic surgeons in preserving the patients' quality of life.
We present the case of 23-year-old woman with no significant medical history. She was initially treated at a nonexpert center for a monophasic synovial sarcoma of the abdominal wall. After undergoing three lines of chemotherapy with no response, she was referred to our department, a sarcoma expert center, for debulking surgery in October 2020. Physical examination revealed a large, firm, and painful subcutaneous mass located in the left iliac fossa, extending into the flank. This mass was beneath a linear scar from prior enucleation surgery and measured approximately 25 cm. A full body CT scan confirmed that the mass was attached to the anterior abdominal wall, with no evidence of invasion into internal abdominal organs or metastatic spread. Because of the large size of the tumor and the consequent full-thickness defect of the anterior abdominal wall, surgical resectability depends on the success of the reconstructive surgery. Given the large tumor size and resulting full-thickness defect of the abdominal wall, the success of the surgical resection heavily relies on the effectiveness of the reconstructive surgery. We successfully performed a two-stage intervention, starting with a laced latissimus dorsi (LD) free flap transfer, followed by oncological resection seven days later. While this technique has been described for head and neck reconstruction, it is, to our knowledge, the first reported use in abdominal wall reconstruction.
Surgical resection remains the cornerstone of treatment for synovial sarcoma, and the extent of resection should not be limited by concerns about defect restoration. The free latissimus dorsi flap, when utilized with careful surgical planning, is an effective option for reconstructing complex abdominal wall defects. This case highlights the importance of advanced reconstructive techniques in ensuring both oncological control and the preservation of the patient quality of life.
躯干和腹壁肉瘤较为罕见，在进行切缘阴性的切除及重建时面临独特挑战，尤其是组织缺损广泛时。这些肿瘤主要影响年轻、活跃的个体，对肿瘤学家和整形外科医生在维持患者生活质量方面构成重大挑战。
我们报告一例23岁女性，既往无重大病史。她最初在一家非专业中心接受腹壁单相滑膜肉瘤治疗。在接受三线化疗无效后，于2020年10月转诊至我们科室（一家肉瘤专家中心）进行减瘤手术。体格检查发现左髂窝有一个大的、质地硬且疼痛的皮下肿块，延伸至侧腹。该肿块位于先前摘除手术留下的线性瘢痕下方，大小约为25厘米。全身CT扫描证实该肿块附着于前腹壁，无侵犯腹腔内器官或转移扩散的证据。由于肿瘤体积大，导致前腹壁全层缺损，手术可切除性取决于重建手术的成功与否。鉴于肿瘤体积大及由此导致的腹壁全层缺损，手术切除的成功很大程度上依赖于重建手术的有效性。我们成功实施了两阶段干预，首先进行带蒂背阔肌（LD）游离皮瓣转移，七天后进行肿瘤切除。虽然该技术已用于头颈部重建，但据我们所知，这是首次报道用于腹壁重建。
手术切除仍然是滑膜肉瘤治疗的基石，切除范围不应受缺损修复问题的限制。精心规划手术时使用游离背阔肌皮瓣是重建复杂腹壁缺损的有效选择。本病例突出了先进重建技术在确保肿瘤控制和维持患者生活质量方面的重要性。
