Oncoplastic Reconstruction of the Anterior Chest Wall Using a Latissimus Dorsi Myocutaneous Flap: A Case Report

Abstract

Background: Dermatofibrosarcoma protuberans (DFSP) is an uncommon cutaneous fibroblastic neoplasm characterized by infiltrative growth, low metastatic potential, and a high risk of local recurrence following incomplete excision. Large or recurrent tumors of the anterior chest wall may require extensive oncologic resection and complex soft-tissue reconstruction. Case Report: We present the case of a 40-year-old woman with a six-year history of an anterior chest wall lesion initially diagnosed as histiocytoma, followed by local recurrence, accelerated growth, and subsequent confirmation of DFSP with positive surgical margins. The tumor measured approximately 10 × 10 × 12 cm and was clinically classified as cT3N0M0. Wide three-dimensional oncologic resection was performed, followed by immediate reconstruction with a pedicled latissimus dorsi myocutaneous flap. The contemporary literature regarding DFSP management and chest wall reconstruction was reviewed. Discussion: Post-traumatic infections of the hand require prompt surgical drainage and targeted antibiotic therapy, as pharmacologic treatment alone is insufficient in the presence of purulent collections. Adequate preparation of the recipient bed represents the most important determinant of successful graft take. In extensive dorsal defects, split-thickness skin grafts offer higher rates of integration due to their lower metabolic demand and greater tolerance to irregularities of the wound bed. Graft incorporation occurs through the sequential phases of plasmatic imbibition, inosculation, and maturation. Early clinical evaluation is therefore essential to identify potential complications and prevent functional impairment. Conclusion: Sequential control of infection followed by coverage with a split-thickness skin graft represents an effective and safe strategy for the management of extensive dorsal hand defects resulting from occupational trauma. This approach provides stable cutaneous coverage and facilitates early functional rehabilitation.