Overcoming Challenges of Recurrent Abdominal Wall Dermatofibrosarcoma Protuberans in a Low-resource Setting: Case...

Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive soft-tissue sarcoma with high recurrence rates. Management of large, recurrent DFSP of the abdominal wall is particularly challenging in low-resource settings due to limitations in specialized care and reconstructive options. A 31-year-old man presented with a recurrent, extensive, fungating abdominal wall mass 8 years after previous surgery. A computed tomography scan revealed an extensive sarcomatous mass, and both fine needle aspiration cytology and incisional biopsy confirmed DFSP. Wide local excision with a 5-cm margin was performed, resulting in a full-thickness abdominal wall defect. Reconstruction was accomplished using a left external oblique myocutaneous flap and a combined pedicled superficial inferior epigastric artery flap with a groin flap (chimeric flap), after intra-abdominal coverage with omentum and mesh. Donor sites were resurfaced with split-thickness skin grafts. A minor wound dehiscence on postoperative day 8 was managed with bedside suturing. The patient was subsequently followed-up and, at the ninth postoperative month, demonstrated an optimal reconstructive outcome with no evidence of recurrence. He was then linked to the oncology unit for ongoing surveillance and care. In resource-limited settings, even extensive recurrent abdominal wall DFSP can be successfully managed with wide excision and strategic regional flap reconstruction when microsurgical options are unavailable.