Challenges of Resection and Reconstruction of a Hemorrhagic Darier and Ferrand Dermatofibrosarcoma Protuberans of the Head in Resource-Limited Setting: A Case Report

Bi Dje – Assi, Valérie Dje; Zunon-Kipre, Yvan; Allah, Konan Christophe; Nasser, Dorian; Sie-Essoh, Jean-Baptiste

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Challenges of Resection and Reconstruction of a Hemorrhagic Darier and Ferrand Dermatofibrosarcoma Protuberans of the Head in Resource-Limited Setting: A Case Report

Valérie Dje Bi Dje – Assi ^*¹

, Yvan Zunon-Kipre²

, Konan Christophe Allah³

, Dorian Nasser

, Jean-Baptiste Sie-Essoh⁴

1- 1. Department of Plastic and Reconstructive and Aesthetic, Hand Surgery and Burn, Teaching Hospital of Treichville, Medical and Sciences Faculty, University Felix Houphouet Boigny, Ivory Coast , assi_valerie@yahoo.fr
2- 2. Department of Neurosurgery, Teaching Hospital of Yopougon, Medical and Sciences Faculty, University Felix Houphouet Boigny, Ivory Coast
3- 1. Department of Plastic and Reconstructive and Aesthetic, Hand Surgery and Burn, Teaching Hospital of Treichville, Medical and Sciences Faculty, University Felix Houphouet Boigny, Ivory Coast
4- 4. Department of Orthopedics Surgery, Teaching Hospital of Yopougon, Medical and Sciences Faculty, University Felix Houphouet Boigny, Ivory Coast

Abstract: (13 Views)

Dermatofibrosarcoma protuberans (DFSP) of Darier and Ferrand located on the head is frequently hemorrhagic. Reconstruction following oncologic resection must carefully balance functional preservation with esthetic outcomes. A 54-year-old woman presented with a recurrent, hemorrhagic tumor on the forehead extending onto the scalp. She underwent surgery by a multidisciplinary team comprising plastic and neurosurgeons. A right anterior cervicotomy was performed. A loop was placed around the external carotid artery (ECA) for a temporary clamping when facing a massive bleeding during the resection of the tumor. Bipolar cautery, targeting ECA branches was done along with progressive running vicryl sutures on the resected margins. A wide oncologic resection of the tumor was carried out. Burring of the outer calvarial table was performed. A split-thickness skin graft was applied after a granulation achieved by a secondary intention wound healing. Residual alopecia was cosmetically concealed with a wig. Histopathological examination confirmed DFSP with negative surgical margins. At 10-year follow-up, the patient remained recurrence-free and expressed high satisfaction with the outcome. This case highlights the management of an hemorrhagic dermatofibrosarcoma protuberans of the head in a limited resource setting where plastic surgeons and neurosurgeons are available. Exposure and placing a vascular loop around the external carotid artery is encouraged. This enables temporary clamping of the artery when facing a massive bleeding. Resection must be wide and oncologically sound. Burring of the outer table of the calvarium is essential when split-thickness skin grafting is selected for defect coverage.

Keywords: Scalp bone burring, Scalp reconstruction, Scalp tumor, SCARE case report, Temporary arterial clamping

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Type of Study: Original Article | Subject: Special