[Introduction to tissue movements - Principles of flaps]

Dermatofibrosarcoma protuberans surgery: Experiences of four African surgical oncology units and literature review

BACKGROUND AND OBJECTIVES

Dermatofibrosarcoma is a locally malignant tumor. This gives surgery a place of choice. The advent of imatinib has improved outcomes. Our aim is to describe the indications, techniques and results of surgery.

METHODS

A retrospective, multicenter, descriptive study conducted in four West African surgical oncology units. It covers dermatofibrosarcoma surgery performed between January 1, 1988 and December 31, 2020. We took into account the surgical procedure, the mode of skin coverage, adjuvant treatments and survival. Comparisons were possible using Student's t-test and Pearson's χ² .

RESULTS

We recorded 81 cases of dermatofibrosarcoma. Surgery was effective in 90.1% of cases. Wide resection was the principle with a mean resection margin of 3.8 ± 1.9 cm. healing by primary intention, flaps and healing by secondary intention were the methods of skin coverage in 30.1%, 24.7% and 41.1% respectively. The type of skin coverage was related to the topography and size of the tumor (p < 0.0001). The healing time is associated with the type of skin cover. The recurrence rate was not related to the type of skin coverage (p = 0.8).

CONCLUSIONS

Wide and deep resection in the absence of Mohs micrographic surgery ensures healthy margins. Oncoplasty reduces the healing time without increasing the risk of recurrence.

Skin oncoplasties: O-to-Z technique a technique of choice in situation of limited resources? Case of Burkina Faso

Background

In developing countries, the long delays in consultation lead to a delay in diagnosis and management of the skin tumors. The lesions are often large and bring the problem of skin coverage after their resections. Several reconstruction techniques allow skin coverage. The objective of this study is to describe the place of O-to-Z technique in the surgical treatment of skin cancers in Ouagadougou. We hypothesized that O-to-Z technique reduces healing times and the number of dressings compared with directed wound healing.

Patients and methods

It was a two-center, retrospective, descriptive study on O-to-Z technique in skin cancers. It included patients who underwent surgery between January 1st, 2013 and March 30th, 2021 in Ouagadougou. Scar quality and healing time in Z-plasty were compared with those of secondary healing. We used the Student’s t test.

Results

In 8 years and 3 months, 171 skin cancers were identified. The mean time to consultation was 13.6 months. The average size of the tumors was 9 cm. An O-to-Z technique was performed in 42 cases, being 58.3% of the patients operated on. The average healing time was 15 days. It was four and a half times shorter in O-to-Z technique than in secondary healing. Ischemic necrosis of the Z-corner was noted in 7 cases. The recurrence rate in O-to-Z technique and secondary healing was 7.1% and 9.1% respectively. Hypertrophic or keloidal scars were noticed in 7 cases and hypochromia in 2 cases.

Conclusion

O-to-Z technique is a technique of choice for skin coverage after large resections in surgical oncology. It reduces the healing time and the cost of postoperative care without increasing the risk of tumor recurrence.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12957-022-02580-8.