We report a 50 y/o male who presented to our hospital with a slow growing vegetating mass over a laparostomy scar after treatment of multiple GSW to the abdomen 20 years before. He sought medical attention after wound fistulization, significant weight loss and general symptoms. He underwent radical abdominal wall excision with 2 cm margins, segmental bowel resection and delayed reconstruction two weeks after validation of clear wound margins with a musculocutaneous Latissimus Dorsi free flap anastomosed to the right deep inferior epigastric vessels. In the immediate postoperative period he presented a distal 15% necrosis of the muscular component and 5% necrosis of the skin component which were treated by surgical debridement and flap advancement with complete healing.
Since the description of malignant changes in burns scars by Jean Marjolin in 1828, the mechanisms of malignization of unstable or chronically inflamed tissues has been elucidated. Now it is recognized that can be originated in a variety of wounds such as pressure sores, venous ulcers, osteomyelitic tracts, and all kind of unstable healed wounds. With the improvement of intensive care, more patients survive severe abdominal trauma, or abdominal medical conditions, and there has been an increase frequency of patients with abdominal wall sequelae and when stable healing has not been achieved and ulceration or fistulization occurs, surgeons have to be always suspicious of malignization.
The ideal treatment for an open abdomen after patient stabilization is primary closure in order to avoid severe complications that can be fatal as Marjolin’s Ulcer. Even though the prognosis of this malignancy is not always good, when judicious approach and treatment are done, long term survival and a good quality of life can be achieved.