Can Ege Yalcin, Servet Yekta Aydin, Cemal Burak Sirkeci, Serkan Melenkis, Berrak Karatan, Oguz Cetinkale
Turkish Journal of Plastic Surgery - 2025;33(4):165-169
introduction Dermatofibrosarcoma protuberans (DFSP) is a rare, slow- growing, yet locally aggressive soft-tissue tumor that originates from the dermis and infiltrates surrounding structures.[1] While metastasis is uncommon, DFSP has a high propensity for local recurrence if not excised with adequate margins.[2] Wide local excision (WLE) with negative margins remains the mainstay of treatment, often necessitating significant soft-tissue resection, particularly when lesions are located in functionally and esthetically critical areas such as the clavipectoral region. While Mohs micrographic surgery offers better margin control with comparable recurrence rates, WLE remains an accepted standard when Mohs is not feasible.[3,4] Defects in the clavipectoral region present unique reconstructive challenges due to their proximity to major neurovascular structures, the shoulder joint, and esthetically sensitive anterior chest contours.[5] While primary closure or skin grafting may be feasible in select cases, larger or deeper defects require well-vascularized soft tissue coverage to ensure optimal wound healing, restore contour, and preserve upper limb mobility.[5] The anterolateral thigh (ALT) flap has been utilized as a workhorse reconstructive option due to its large skin paddle, Background: Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive soft-tissue tumor requiring wide local excision (WLE) to minimize recurrence. The anterolateral thigh (ALT) flap is a versatile option for reconstruction, offering ample soft tissue coverage with minimal donor site morbidity. This study aims to evaluate the outcomes of ALT flap reconstruction following DFSP excision in the clavipectoral region, focusing on surgical technique, oncologic safety, functional recovery, and patient satisfaction. Patients and Methods: A retrospective review of patients who underwent WLE for DFSP in the clavipectoral region, followed by ALT flap reconstruction, was conducted over a 10-year period. Data were collected on patient demographics, tumor characteristics, surgical details, postoperative complications, functional recovery, and recurrence rates. Functional outcomes were assessed based on range of motion, esthetic satisfaction, and donor site morbidity. Results: A total of 4 male patients (mean age: 42.3 +/- 14.7 years) were included. The mean defect size was 12 cm x 10.1 cm. No postoperative complications were observed. Mean follow-up was 40.8 months, with all patients reporting satisfactory esthetic outcomes and no functional limitation. No cases of local recurrence were observed within the follow-up period. Conclusion: ALT flap reconstruction following DFSP excision in the clavipectoral region provides reliable soft-tissue coverage and results in high patient satisfaction. Its low donor site morbidity and excellent vascularity make it a preferred option for reconstructive surgeons.
