title: A novel combined surgical approach to head and neck dermatofibrosarcoma protuberans.
abstract: BACKGROUND
  The surgical management of dermatofibrosarcoma protuberans has historically been a challenge, particularly in the head and neck and other aesthetic areas. The current priority is to achieve local oncologic control and a good reconstructive outcome. Here, we present our experience using a novel combined approach with a dermal regenerative template, sub-atmospheric pressure and skin graft.
  
  
  METHODS
  Five patients presenting at the Department of Plastic and Reconstructive Surgery of the University of Florence between January 2010 and October 2011 were included in the study following Institutional Review Board approval. All patients underwent a wide local excision of dermatofibrosarcoma protuberans affecting the head and neck.
  
  
  RESULTS
  The combined approach using the negative-pressure device, a dermal regenerative template and skin grafting proved effective in the management of this type of sarcoma with a good aesthetic and functional outcome, particularly on the neck or the supraclavicular region.
  
  
  CONCLUSIONS
  Although the present multi-step technique requires patient compliance, it results in good local oncologic control of the resection margins. It is possible to perform a wider excision in the event of positive margins without interfering with the last reconstructive outcome.
authors.affiliation: Department of Plastic and Reconstructive, CTO-AOUC, University of Florence, Largo Palagi 1, 50134, Italy; Department of Maxillo-Facial Surgery, CTO-AOUC, University of Florence, Italy. Electronic address: tommasoagostini@ymail.com.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Agostini
authors.forename: Mario
authors.initials: M
authors.lastname: Dini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Quattrini Li
authors.forename: Luca
authors.initials: L
authors.lastname: Grassetti
authors.forename: Andrea
authors.initials: A
authors.lastname: Mori
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Spinelli
authors.forename: Giulia Lo
authors.initials: GL
authors.lastname: Russo
authors.forename: Davide
authors.initials: D
authors.lastname: Lazzeri
mesh_terms: D003131:Combined Modality Therapy; D018223:Dermatofibrosarcoma / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D019651:Plastic Surgery Procedures / Q000379:methods*; D012038:Regeneration / Q000502:physiology; D012535:Scalp / Q000601:surgery; D012878:Skin Neoplasms / Q000601:surgery; D016038:Skin Transplantation / Q000379:methods; D017768:Skin, Artificial; D016896:Treatment Outcome; D055815:Young Adult
keywords: Dermal regenerative template; Dermatofibrosarcoma protuberans; Head and neck; Skin graft; Vacuum-assisted closure