A Multidisciplinary Approach to Complex Dermal Sarcomas Ensures an Optimal Clinical Outcome

Figures

• 

  Figure 1. This figure illustrates a complex case of DFSP with infiltration to the sternum. (a) The initial appearance of the tumour prior to radiotherapy. (b) Defect after tumour resection with 3 cm margins and partial sternum resection. The defect measured 22 × 20 cm. (c) Defect reconstruction was achieved by use of a free conjoined parascapular and latissimus dorsi flap, which was anastomosed to the right internal mammary and vein in an end-to-end fashion [13]. (d) The result at 4-month follow-up.

• 

  Figure 2. Microsurgical scalp reconstruction after resection of DUPS/AFX. Following an incomplete surgical resection and postoperative radiation of atypical fibroxanthoma on the scalp, this patient developed a local recurrence of DUPS/AFX 1 year after radiation therapy (a). The soft tissue and skull bone were resected with free margins in an interdisciplinary setting by neurosurgeons and reconstructive surgeons while the dura was preserved (b). The 9 × 10 cm bone-and soft tissue defect was covered by use of Palacos bone cement® followed by a free latissimus dorsi flap (end-to-end anastomosis to the right temporal artery) and split skin from the thigh for cover (c). A photo of the result at follow-up at three months is displayed at the bottom right (d).

• 

  Figure 3. A case of cutaneous angiosarcoma (RIAS) of the left thoracic wall. The patient developed an angiosarcoma after radiation therapy targeting invasive, ductal breast cancer of the left breast. After complete resection of the radiation field including a part of the left clavicle and costa I (a,b), a free myocutaneous latissimus dorsi flap was raised and transposed, followed by an end-to-end anastomosis to the right internal mammary artery. Split skin was harvested from the thigh to cover the flap (c). Adjuvant chemotherapy (Doxorubicin, Adriamycin and Ifosfamide, and Dacarbazine) was given. After 6 months, the patient presented with a satisfactorily aesthetic and excellent reconstructive result (d).