LAUSR

Surgical repair of a complex defect after resection of Dermatofibrosarcoma protuberans. Materials-methods: Dermatofibrosarcoma protuberans, is an uncommon soft tissue tumor that involves the dermis, subcutaneous fat, and in rare cases, muscle and fascia. We present a 49-year-old patient diagnosed with Dermatofibrosarcoma of the anterior abdominal wall who underwent Mohs surgery to achieve complete resection, resulting in a 12cmx10cm defect in the epigastrium affecting skin, subcutaneous tissue, linea alba and both anterior rectus sheaths. This tumor is considered an intermediate-grade malignancy with a low likelihood of metastasis but a high local recurrence rate. The optimal treatment is Mohs-micrographic surgery, that allows complete margin assessment and tissue preservation. Dissection of the retrorectus space is extended caudal to the defect, while dissection proceeded cranially by sectioning the posterior rectus sheath to enter the subxiphoid preperitoneal space. A polypropylene mesh is extended in sublay position. Given the asymmetry of anterior fascia defect, the Chevrel (Welti-Eudel) technique is performed on the left side in order to reconstruct the linea alba. The fascial defect was later covered with an onlay biosynthetic mesh. Finally, closure of the skin was achieved with an O-Zetaplasty ensuring adequate viability of the skin flaps. The patient did not present any postoperative complications. Resection of locally aggressive tumours such as Dermatofibroma remains the only curative alternative but can pose a reconstructive challenge. Midline reconstruction and closure of large, circular defects in the epigastrium is complicated, requiring deep anatomical knowledge and a combination of different surgical approaches and materials.