Dermatofibrosacroma protuberans of the thigh surgically reconstructed with free tram flap: Case report

Abstract

Dermatofibrosarcoma Protuberans (DFSP) is a malignant fibro-blastic tumor most common in middle aged adults. It grows slowly and  has low metastatic potential but a high recurrence rate. The recommended management option is wide surgical excision with 3-5cm  margins or Mohrs micro-graphic surgery. Radiotherapy has mixed outcome, and the tumor is generally resistant to chemotherapy. Use of Imatinib a cytosine kinase inhibitor has shown promise in disseminated disease. The free TRAM flap has increased options for  reconstruction and soft tissue cover since its introduction and wide use by reconstructive surgeons. Free tram use has been widely  described in breast reconstruction and other soft tissue defects. We present a case of a 34-year-old female patient with a recurrent dermatofibrosarcoma protuberans. Free TRAM flap in reconstruction of a proximal lower limb defect after fourth recurrence. The free  TRAM flap was successfully used to provide cover for the defect after wide local excision. In conclusion, the Free TRAM flap is a viable  option for covering lower limb defects. It provides good bulk, has a reliable pedicle and minimal donor site morbidity in the surgical  management of dermatofibrosarcoma Protuberans.