Pectoralis Major Myocutaneous Flap for Chest Wall Reconstruction After Dermatofibrosarcoma Protuberans Resection: A Case Report

Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous soft tissue sarcoma characterized by slow growth but significant local aggressiveness and a high risk of recurrence when inadequately excised. Its clinical presentation may mimic benign lesions, frequently leading to delayed diagnosis and suboptimal initial management. Achieving complete surgical resection with negative margins remains the cornerstone of treatment; however, wide excision often results in complex soft tissue defects that require appropriate reconstructive strategies. We present the case of a 49-year-old man with a recurrent infraclavicular lesion initially misdiagnosed as a keloid and treated without histopathological confirmation. Following recurrence, a biopsy established the diagnosis of DFSP. The patient underwent wide local excision (WLE) with oncologic margins, resulting in a full-thickness defect measuring approximately 6 cm in diameter. Immediate reconstruction was performed using a pedicled pectoralis major myocutaneous flap designed to provide reliable vascularized coverage and allow tension-free closure. Histopathological examination confirmed DFSP with negative surgical margins; the closest margin measured 0.5 cm. The postoperative course was uneventful, and the patient remains free of local recurrence or metastasis after four years of follow-up. This case highlights the importance of the early histopathological evaluation of atypical cutaneous lesions and underscores the role of reconstructive surgery as an integral component of oncologic management. In selected cases, pedicled myocutaneous flaps provide a reliable and effective option for immediate reconstruction, enabling adequate tumor resection while preserving functional and aesthetic outcomes.