مجله جهانی جراحی پلاستیک
مجله جهانی جراحی پلاستیک
شنبه 25 مهر 1405
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چکیده: (18 مشاهده)
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.
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