Sunday, October 28, 2007

The Use Of Wide Local Excision And Temporary Wound V.A.C. Dressing In Treating Two Cases Of DFSP

Stephen Pearson, MD and James K. Amsberry, MD.

Dermatofibroscarcoma protuberans is an uncommon cutaneous malignancy with a high local recurrence rate. At Naval Medical Center San Diego, the Department of Plastic Surgery has played an instrumental role in the surgical treatment of these tumors. We present two recent cases of DFSP, which were successfully treated with wide local excision and interim wound management with the Wound V.A.C., a commercially available negative pressure dressing. In both cases the Wound V.A.C. was applied at the time of initial excision. The dressings were changed every 3-5 days until permanent pathology was available. In one case, pathology revealed tumor within 1mm of the margin, and the patient underwent subsequent re-excision. Definitive wound management was accomplished after the margins were reported clear in both cases. Although Mohs micrographic surgery has proven beneficial in the treatment of DFSP, we believe our cases demonstrate a successful alternative. The potential advantages this combination offers include: (1) a more reliable pathologic specimen, when compared to frozen section, (2) decreased wound care and dressing changes, (3) an optimal wound bed for definitive management, and (4) far less technical procedure when compared to a Mohs excision, meaning a non-Mohs trained surgeon could adequately treat these tumors.

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