Abstract
Introduction
Dermatofibrosarcoma protuberans (DFSP) is a relatively rare malignant tumor, with
important local aggressiveness.
Case report
We present a case of a 59-years-old man with a history of Psoriasis and viral hepatitis
C presented in our department with a giant lesion on the posterior trunk, of 24/36 cm,
with pus and local bleeding, causing important anemia. The tumor was excised, creating
an elliptical defect of around 34 × 42 cm down to fascial level, which was covered
by two lateral flaps – modified Keystone type III.
Results
The flaps were completely viable and integrated with small dehiscence, which were
assisted to heal secondarily.
Conclusion
Our paper presents a reliable alternative to skin grafting for a very large defect
on the posterior trunk, the modified type III keystone flap, to our knowledge, for
the first time presented for such a wide defect and on adult.
Keywords
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References
- Dermatofibrosarcoma protuberans (DFSP) with fibrosarcomatous changes in a patient with psoriasis treated with adalimumab.JAAD Case Reports. 2015; 1 ([Internet]Available from:): 272-273
- Dermatofibrosarcoma protuberans: insights into a rare soft tissue tumor.J Clin Imaging Sci. 2016; 6: 16https://doi.org/10.4103/2156-7514.181492
- Dermatofibrosarcoma protuberans: MR IM- aging features.AJR Am J Roentgenol. 2002; 178: 989-993
- Dermatofibrosarcoma protuberans.Med (Baltimore). 2015; 94 ([Internet]Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00005792-201506030-00037): e1001
- A large gradually increasing cutaneous swelling on lower back.J Cutan Aesthet Surg. 2010; 3: 45-47https://doi.org/10.4103/0974-2077.63300
- Surgical treatment of enormous recurrent dermatofibrosarcoma protuberans.Thorac Cardiovasc Surg Rep. 2015; 4: 2-4https://doi.org/10.1055/s-0034-1387822
Al-naami A.Q., Khan L.A., Amin K., Al-naami A.M., Sun Z. Dermatofibrosarcoma protuberans — a rare neoplasm. 2016;6(2):229–30.
- Management of posterior trunk defects.Plast Reconstr Surg. 2006; 118: 73e-83e
- Reconstructive options for large back free flap donor sites.ANZ J Surg. 2017; ([Internet]Available from)
- The keystone design perforator island flap in reconstructive surgery.ANZ J Surg. 2003; 73: 112-120
- Dermatofibrosarcoma protuberans: a case report of a rare, bulky tumor that was managed with surgical therapy.Int J Shoulder Surg. 2009; 3: 16-20https://doi.org/10.4103/0973-6042.48432
- Dermatofibrosarcoma: a rare neoplasm of skin.BMJ Case Rep. 2012; : 9-11
- Dermatofibrosarcoma protuberans: a case report and review of the literature.Hippokratia. 2016; 20: 80-83
- Dermatofibrosarcoma protuberans.Ind Dermatol Online J. 2017; 8: 495-497https://doi.org/10.4103/idoj.IDOJ_424_16
- Dermatofibrosar- coma protuberans: a case report and review of the literature.J Clin Aesthet Dermatol. 2008; 1: 34-36
- Role of surgery in the management of dermatofibrosarcoma protuberans.Ann Surg. 1961; 154: 255-258
- Wide local excision for dermatofibrosarcoma protuberans: a single-center series of 90 patients.Biomed Res Int. 2015; 2015 (Epub 2015 Nov 25)642549https://doi.org/10.1155/2015/642549
- Dermatofibrosarcoma protuberans arising in a decorative tattoo.Sarcoma. 2005; 9: 37-41
- Dermatofibrosarcoma protuberans: our experience of 59 cases.Oncol Lett. 2012; 4: 1047-1055
- Clinicopathological features of dermatofibrosarcoma protuberans.Oncol Lett. 2016; 11: 661-667
- Congenital dermatofibrosarcoma protuberans with fibrosarcomatous and myxoid change.J Clin Pathol. 2005; 58: 984-986
- A giant fungating metastatic basal cell carcinoma of the back and novel reconstruction using two large keystone design island perforator flaps.J Plast Reconstr Aesthetic Surg. 2013; 66: 1015-1018
- A comparison of full and split thickness skin grafts in radial forearm donor sites.J. Hand Microsurg. 2011; 3: 18-24
- Safety and efficacy of the keystone and rhomboid flaps for immediate reconstruction after wide local excision of non-head and neck melanomas.World J Surg Oncol. 2016; 14 ([Internet]Available from:): 269
- Closure of a large thoracolumbar myelomeningocele using a modified bilateral keystone flap.Plast Reconstr Surg - Glob Open. 2016; 4 ([Internet]Available from:): e1114
- The keystone design perforator island flap in reconstructive surgery.Anz J Surg. 2003; 73: 261
- Precautions in using keystone flap.J Plast Reconstr Aesthetic Surg. 2010; 63 ([Internet]Available from): 720
- The interpretation of vascular changes observed in keystone island flaps: a hypothesis.J Plast Reconstr Aesthetic Surg. 2010; 63 ([Internet]Available from): e215-e216
- Nodular fasciitis complicating a staged surgical excision of dermatofibrosarcoma protuberans.Case Rep Dermatol Med. 2016; 2016 ([Internet]Available from): 1-5
- Keystone island flap.Plast Reconstr Surg - Glob Open. 2016; 4 ([Internet]Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=01720096-201602000-00013): e617
- Dermatofibrosarcoma protuberans of the toe: findings on multiple imaging modalities.Clin Nucl Med. 1993; 18: 978-980
- Keystone flap: versatile flap for reconstruction of limb defects.J Clin Diagn Res. 2015; 9: PC05-PC07
Article info
Publication history
Published online: October 23, 2019
Footnotes
This paper is part of a Supplement supported by the European Federation of Societies of Microsurgery (EFSM) and the Serbian Society for Reconstructive Microsurgery (SSRM).
Identification
Copyright
© 2019 Elsevier Ltd. All rights reserved.