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Abstract：
BACKGROUND: Dermatofibrosarcoma protuberans (DFSP) is a rare skin fibroblastic tumor, with a high rate of recurrence. The treatment of DFSP is generally surgical, and wide local excision is the mainstay of surgical treatment. Therefore, complete assessment of all surgical margins is fundamental before definitive reconstruction. The reconstruction is a challenge for plastic surgeons, especially in particular anatomical areas (for aesthetic or functional problems) or in patients who are not candidates for more complex surgical treatments. We describe an alternative approach for reconstructive treatment of the lumbar area after wide excision of DFSP (without fresh-frozen sections) in a young obese woman with a history of smoking, using a new type of acellular dermal matrix (ADM) in a combined management protocol. The benefits of ADM are numerous: immediate wound closure and prevention of infections and excessive drying; minimal donor site morbidity; and good functional and aesthetic outcomes. Moreover, it is a temporary cover while the anatomical specimen is histologically analyzed, without donor site morbidity or prevention of any future surgery (if the margins are not tumor-free) or radiotherapy.
METHODS: In October 2019, a 34-year old obese Caucasian Woman with a history of smoking came to our institute for a multinodular growing polypoid mass in her lumbar region. An incisional biopsy diagnosed DFSP. The patient underwent proper staging. A wide local excision with 3 cm clinically healthy tissue margins down to the muscle fascia was performed and the defect was repaired using a combined approach with a new artificial bilaminar dermal template (Pelnac®, Gunze Ltd., Osaka, Japan) and a negative-pressure wound therapy system (V.A.C.®, KCI, San Antonio, USA). After the final histological examination revealed tumor-free margins, a split-thickness graft was harvested from the right gluteus and fixed to the new derma with negative-pressure wound therapy. Postoperative radiotherapy was not necessary. After 15 days, the wound had healed without complications, with satisfactory aesthetic outcome and with no limitation of back motion or pain. After 6 months of follow-up, the patient was free from disease.
CONCLUSIONS: This is the first reported case of Pelnac® use in DFSP reconstruction of the lumbar region. We believe that the multistep approach described herein may be a good alternative approach in selected patients with wide resections in particular anatomical areas, especially when frozen sections (with Mohs micrographic surgery) are not available.
METHODS: In October 2019, a 34-year old obese Caucasian Woman with a history of smoking came to our institute for a multinodular growing polypoid mass in her lumbar region. An incisional biopsy diagnosed DFSP. The patient underwent proper staging. A wide local excision with 3 cm clinically healthy tissue margins down to the muscle fascia was performed and the defect was repaired using a combined approach with a new artificial bilaminar dermal template (Pelnac®, Gunze Ltd., Osaka, Japan) and a negative-pressure wound therapy system (V.A.C.®, KCI, San Antonio, USA). After the final histological examination revealed tumor-free margins, a split-thickness graft was harvested from the right gluteus and fixed to the new derma with negative-pressure wound therapy. Postoperative radiotherapy was not necessary. After 15 days, the wound had healed without complications, with satisfactory aesthetic outcome and with no limitation of back motion or pain. After 6 months of follow-up, the patient was free from disease.
CONCLUSIONS: This is the first reported case of Pelnac® use in DFSP reconstruction of the lumbar region. We believe that the multistep approach described herein may be a good alternative approach in selected patients with wide resections in particular anatomical areas, especially when frozen sections (with Mohs micrographic surgery) are not available.
摘要：
背景：隆突性皮肤纤维肉瘤（DFSP）是一种罕见的皮肤成纤维细胞肿瘤，复发率高。DFSP的治疗通常是手术，广泛的局部切除是手术治疗的主要手段。因此,在最终重建之前，对所有手术切缘进行完整评估是至关重要的。重建对整形外科医生来说是一个挑战，特别是在特定的解剖区域（用于美学或功能问题）或不适合进行更复杂手术治疗的患者中。我们描述了在一名有吸烟史的年轻肥胖女性中广泛切除DFSP（无新鲜冷冻切片）后对腰椎区域进行重建治疗的替代方法。在联合管理方案中使用新型脱细胞真皮基质（ADM）。ADM的好处很多：立即闭合伤口并预防感染和过度干燥；最小的供体部位发病率；以及良好的功能和美学结果。此外，这是一个暂时的覆盖，而解剖标本是组织学分析，没有供体部位的发病率或预防任何未来的手术（如果边缘不是无肿瘤）或放疗。
方法：2019年10月，一名34岁有吸烟史的肥胖白种人女性来到我们的研究所，因为她的腰椎区域有多结节样肿块。切口活检诊断为DFSP。患者接受了适当的分期。进行了3厘米临床健康组织边缘向下至肌肉筋膜的广泛局部切除术，并使用新的人工双层真皮模板联合方法修复了缺损（Pelnac®，GunzeLtd.,大阪,日本）和负压伤口治疗系统（V.A.C.®，圣安东尼奥KCI,美国）。最终组织学检查显示无瘤边缘，我们从右侧臀肌获取厚薄的移植物,并通过负压伤口治疗固定在新的皮肤上.术后不需要放疗。15天后,伤口愈合，没有并发症，具有令人满意的美学效果，并且背部运动或疼痛没有限制。经过6个月的随访，病人没有疾病。
结论：这是第一例报道的Pelnac®用于腰椎区域的DFSP重建。我们认为，本文所述的多步骤方法可能是在特定解剖区域进行广泛切除的选定患者的良好替代方法。特别是当冷冻切片（使用Mohs显微手术）不可用时。
方法：2019年10月，一名34岁有吸烟史的肥胖白种人女性来到我们的研究所，因为她的腰椎区域有多结节样肿块。切口活检诊断为DFSP。患者接受了适当的分期。进行了3厘米临床健康组织边缘向下至肌肉筋膜的广泛局部切除术，并使用新的人工双层真皮模板联合方法修复了缺损（Pelnac®，GunzeLtd.,大阪,日本）和负压伤口治疗系统（V.A.C.®，圣安东尼奥KCI,美国）。最终组织学检查显示无瘤边缘，我们从右侧臀肌获取厚薄的移植物,并通过负压伤口治疗固定在新的皮肤上.术后不需要放疗。15天后,伤口愈合，没有并发症，具有令人满意的美学效果，并且背部运动或疼痛没有限制。经过6个月的随访，病人没有疾病。
结论：这是第一例报道的Pelnac®用于腰椎区域的DFSP重建。我们认为，本文所述的多步骤方法可能是在特定解剖区域进行广泛切除的选定患者的良好替代方法。特别是当冷冻切片（使用Mohs显微手术）不可用时。
