Outcomes of Surgery for Dermatofibrosarcoma Protuberans and Risk Factor Analysis for Recurrence

PURPOSE: Dermatofibrosarcoma protuberans is a relatively rare tumor that originates from the dermis and subcutaneous tissue. It is generally known that this tumor easily recurs but can be successfully treated with a wide excision. Therefore, this study was conducted to investigate postoperative outcomes and risk factors for recurrence in patients with dermatofibrosarcoma protuberans who were treated at a single institution for 20 years. METHODS: We retrospectively reviewed the medical records of 35 patients who had underwent surgery between June 1992, and September 2010. The patients were assessed in terms of predilection site and size of the tumor, the incidence according to sex, discrepancy between biopsy results and histopathological diagnosis of the surgical specimen, additional treatment after recurrence, recurrence rate and the time interval to recurrence. RESULTS: In multivariate analysis, the depth and site of the tumor were significant risk factors for tumor recurrence. The recurrence rate was significantly higher in tumors occurring in the upper extremity than those occurring in other regions(p=0.0348). In addition, the recurrence rate was significantly higher in tumors with involvement of the fascia and the deeper structures(p=0.0324, odds ratio=6, relative risk=1.588). Since dermatofibrosarcoma protuberans has strong invasiveness, its tissue involvement is difficult to evaluate accurately. CONCLUSION: The results of this study shows that involvement of the fascia and the deeper structures and occurrence in the upper extremity were associated with tumor recurrence. Therefore, clinicians should be aware of these risk factors to achieve better treatment outcomes.

Prevention of Secondary Depression Deformity after Tissue Expansion

Tissue expansion is commonly used method in reconstruction of skin defect after removal of various skin lesions or scars in face, trunk and extremities. However, the expansion pressure not only expands the overlying skin but also compresses the base tissue itself, which may result in depression or asymmetry. Many patients could not be satisfied with these deformities although their skin lesions were removed and reconstructed successfully. Many plastic surgeons have not taken into consideration of these facts. A total of 24 patients underwent 36 implants. The authors tried to fill the depression by manipulating surrounding capsular tissues with elevation of the capsular flap and its transposition to the depressed area, free graft of the resected capsular tissues into the depression. We also used adjacent soft tissues such as fascial flaps to fill the depression and prevented the expected depression deformity or asymmetry after removal of tissue expander. With this method, we achieved satisfactory aesthetic results without depression. There happened 4 cases of remnant depression due to under correction of it and 2 cases of hematoma formation and 1 case of skin necrosis.

Correction of Drooping Mouth Corner due to Cheek Mass by Suspension with Nasolabial Dermal Flap

Benign tumor in the cheek area such as hemangioma, lymphangioma and neurofibroma causes the drooping of affected side soft tissue involving cheek, mouth corner and nasolabial fold due to its heavy weight and bulkiness. The drooping of mouth corner may remain even after partial subcutaneous excision of the mass. The authors suspended the drooped mouth corner with dermal flap which could be elevated through the nasolabial fusiform de-epithelization simultaneously while the mass was removed by the incision. A total of 14 patients with hemangioma, lymphangioma and neurofibroma in the cheek area were operated between February 1998 and November 2001. The age distribution was 5 to 21-years-old and the follow-up period ranged from 5 to 37 months. There were 1 case of epidermal inclusion cyst and 1 case of hematoma, but no infection or facial nerve palsy was reported as complication. The aesthetic results were considered favorable. This technique prevents the drooping of mouth corner or asymmetry of mid-face without remaining any significant deformity at the donor site, and helps to make more normalized facial feature after the removal of soft tissue mass in the cheek.