Surgical removal of infraauriculer recurrent dermatofibrosarcoma protuberans and reconstruction with bilobed flap

Öz

Dermatofibrosarcoma protuberance is a rare skin tumor which has slowly growing, low metastasis capacity but can be locally agressive. This is a case report about a patient who was operated in an other medical center for dermatofibrosarkom protüberans and the tumor recurred after a short time. The tumor was reexcised with free surgical 2 cm margin with also superficial parotidektomy was done. Skin defect was covered by bilobed flap. The pathological specimen was reported as dermatofibrosarcoma protuberance. There is no recurrence or metastasis for 12 months follow-up of patient. A rare is use of the bilobed flap in the head and neck region after large tumoral lesion excision. In our opinion, the revised reconstructive technique provides lots of advantages, improves aesthetical results and provides more natural appearance.

Anahtar Kelimeler

• Rekürren dermatofibrosarkoma protuberans, soft tissue sarcomas, superficial paratidectomy

İnfraauriküler rekürren dermatofibrosarkoma protuberans\'ın cerrahi eksizyonu ve bilobe flep ile rekonstrüksiyonu

Öz

Dermatofibrosarkom protüberans cildin nadir görülen sarkomudur. Yavaş büyüyen, lokal invaziv ve uzak metastaz potansiyeli nadir neoplazmlardır. Bu makalede daha önce başka bir merkezde ameliyat olan ancak çok kısa süre içinde aynı bölgede tekrar eden dermatofibrosarkom protüberans olgusu sunuldu. Tümörün tamamı, 2 cm cerrahi negatif sınırda ve süperfisyal parotidektomi ile rezeke edildi. Oluşan geniş cilt defekti bilobe flep ile kapatıldı. Patoloji sonucu dermatofibrosarkom protüberans olarak bildirildi. Hastanın 12 aylık klinik takibinde, herhangi bir lokal nüks ya da uzak organ metastazıyla karşılaşılmadı. Geniş tümöral lezyon eksizyonlarından sonra baş boyun bölgesinde bilobe flebin kullanımı nadirdir. Bizce bu rekonstrüktif teknik estetik birçok avantaj sağlar ve daha çok doğal görünüm sağlar.

Anahtar Kelimeler

• Rekürren dermatofibrosarkoma protuberans, yumuşak doku sarkomları, Yüzeyel Parotidektomi

Kaynakça

1. Darier JF, Ferrand M. Dermato-fibromes progressifs et ré- cidivantes ou fibro-sarcomes de la peau. Annales de derma- tologie et de syphilographie 1924;5:45-62.
2. Hoffmann E. Uber das knollentreibende Fibrosarkom der haut (Dermatofibrosarkoma protuberans). Dermat Ztschr 1925;43:1-4.
3. Fiore M, Miceli R, Mussi C, et al. Dermatofibrosarcoma pro- tuberans treated at a single institution: a surgical disease with a high cure rate. J Clin Oncol 2005;23:69-75.
4. Kransdorf MJ, Meis-Kindblom JM. Dermatofibrosarcoma protuberans: radiologic appearance. AJR Am J Roentgenol 1994;163:391-394.
5. Miyakawa E, Fujimoto H, Miyakawa K, et al. Dermatofibro- sarcoma protuberans. CT findings with pathologic correla- tion in 6 cases. Acta Radiol 1996;37:362-365.
6. Turgut AT, Koşar U, Ergeneci A, Çakmak H. Lokal rekürens bulunmaksızın akciğer metastazı gösteren dermatofibro- sarkom protüberans. Türk Tanısal ve Girişimsel Radyoloji Dergisi 2003;9:195-198.
7. Murphy SJ. Dermatofibrosarcoma protuberans: early rec- ognition and treatment. Am Fam Physician 2000;62:1257- 1258.
8. Brabant B, Revol M, Vergote T, et al. Dermatofibrosarcoma protuberans of the chest and the shoulder: wide and deep excisions with immediate reconstruction. Plast Reconstr Surg 1993; 92:459-462.

9. Zimany A. The bilobed flap. Plast Reconstr Surg 1953;11:424.
10. McGregor JC, Soutar DS. A critical assessment of the bi- lobed flap. Br J Plast Surg 1981; 34: 197-205.
11. Kimmel Z, Ratner D, Kim JY, et al. Peripheral excision mar- gins for dermatofibrosarcoma protuberans: a meta-analysis of spatial data. Ann Surg Oncol 2007;14:2113-20
12. Gayner SM, Lewis JE, McCaffrey TV. Effect of resec- tion margins on dermatofibrosarcoma protuberans of the head and neck. Arch Otolaryngol Head Neck Surg. 1997;123:4:430-433.
13. Ballo MT, Zagars GK, Pisters P, Pollack A. The role of ra- diation therapy in the management of dermatofibrosarcoma protuberans. Int J Radiat Oncol Biol Phys 1998;40:823- 827.
14. Suit H, Spiro I, Mankin HJ, et al. Radiation in management of patients with dermatofibrosarcoma protuberans. J Clin Oncol 1996;14:2365-2369.
15. Esser JFS Gestielte lokale nasenplastik mit zwei zipfligen lappen, deckung des sekundaren Defektes vom ersten Zip- fel durch dem zweiten. Dtsch Z Chir 1918;143:385.