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PubMedDate not supplied

Low-grade sarcomas with CD34-positive fibroblasts and low-grade myofibroblastic sarcomas.

A subset of low-grade fibrosarcomas is composed of CD34-positive spindle cells. These include dermatofibrosarcoma, its morphologic variants, and its associated fibrosarcoma, solitary fibrous tumor, hemangiopericytoma and their malignant counterparts, and some cases of myxoinflammatory fibroblastic sarcoma. Dermatofibrosarcoma and related lesions are characterized by a t(17;22)(q22;q13) rearrangement resulting in fusion of the genes COL1A (17q21-22) and PDGFB1 (22q13). Solitary fibrous tumor displays varying cellularity and fibrosis and a peripheral hemangiopericytomatous pattern; most tumors formerly called hemangiopericytoma are now subsumed into the category of solitary fibrous tumor, although a few strictly defined examples are recognized; however, these are probably not composed of pericytes. Myofibroblastic malignancies are best identified by electron microscopy, with which varying degrees of differentiation, including the presence of fibronexus junctions, can be identified. Low-grade sarcomas showing myofibroblastic differentiation include myofibrosarcomas and inflammatory myofibroblastic tumors. Myofibrosarcomas are spindle cell neoplasms that occur in children or adults in the head and neck, trunk, and extremities as infiltrative neoplasms and that display a fascicular or fasciitis-like pattern with focal nuclear atypia and variable expression of myoid antigens. These sarcomas are prone to recurrence and a small number metastasize. Inflammatory myofibroblastic tumor (synonymous with inflammatory fibrosarcoma) is a neoplasm arising predominantly in childhood, and frequently in intraabdominal locations. It has spindle cells in fascicular, fasciitis-like and sclerosing patterns, with heavy chronic inflammation including abundant plasma cells. Many IMT have clonal chromosomal abnormalities involving 2p22-24, and fusion of the ALK gene with tropomyosin 3 (TPM3-ALK) or tropomyosin 4 (TPM4-ALK) is found in a subset.

Antigens, CD34↗

PubMed1981

Immunohistochemical identification of lysozyme in cutaneous lesions of alleged histiocytic nature.

Histiocytosis X, multicentric reticulohistiocytosis, juvenile xanthogranuloma, the "fibrous" type of dermatofibroma, dermatofibrosarcoma protuberans, and malignant fibrous histiocytoma are all characterized by dermal and/or subcutaneous infiltrates composed at least partially of cells having morphologic features suggestive of histiocytes. Paraffin-embedded tissues representing these conditions were stained for lysozyme (muramidase) with a peroxidase-antiperoxidase technic. The cells of juvenile xanthogranuloma were rich in lysozyme. Some of the cells of histiocytosis X showed a positive pattern, and the cells of the other three conditions were essentially negative. This study confirmed the histiocytic nature of juvenile xanthogranuloma and multicentric reticulohistiocytosis, supported the interpretation that there is a histiocytic component in the lesions of histiocytosis X, and cast some doubt on the alleged histiocytic nature of "fibrous" dermatofibroma, dermatofibrosarcoma protuberans, and malignant fibrous histiocytoma.

Fibroma↗

PubMed2002

Expression of claudin-1, a recently described tight junction-associated protein, distinguishes soft tissue perineurioma from potential mimics.

Perineuriomas are rare benign soft tissue tumors having an immunophenotype paralleling the normal perineurial cell [S-100 protein negative and epithelial membrane antigen (EMA) positive]. Because EMA expression in perineuriomas may be focal and/or faint, there is continued interest in the development of new markers of perineurial differentiation. Perineurial cells differ from almost all other mesenchymal cell types by virtue of their formation of tight junctions. In the course of evaluating a group of novel tight junction-associated proteins, we noted high levels of expression of claudin-1 by normal perineurial cells and have systematically extended these observations to perineuriomas. Twelve EMA-positive/S-100-negative perineuriomas were retrieved from our consultation archives and compared with 39 tumors in the differential diagnosis of perineurioma (seven dermatofibrosarcoma protuberans, eight low-grade fibromyxoid sarcomas, three desmoplastic fibroblastomas, seven fibromatoses, nine neurofibromas, and five schwannomas). All cases were immunostained for claudin-1 using standard avidin-biotin technique. Cases were scored as 3+ (>50% positive cells), 2+ (25-50% positive cells), and 1+ (5-24% positive cells). In all cases positive internal controls in the form of epithelium, normal perineurium, or endothelial cells were present. Positive staining for claudin-1 was visualized in a distinctly particulate pattern along the cell membrane. Cytoplasmic staining was infrequent and was not scored as positive. Claudin-1 expression was present in 11 of 12 (92%) perineuriomas studied (seven at 3+, three at 2+, and one at 1+). In all but two cases, the degree of claudin expression was equal to or greater than the corresponding EMA immunostain. Claudin-1 expression was not noted in any cases of dermatofibrosarcoma protuberans, low-grade fibromyxoid sarcoma, desmoplastic fibroblastoma, or fibromatosis. Six of nine cases of neurofibroma contained a significant number of claudin-1-positive cells that were thought to be perineurial in origin, based on the staining of long, delicate cytoplasmic processes. One of four schwannomas contained a subpopulation of perivascular, dendritic, claudin-1-positive cells of presumed perineurial lineage. This is the first study to document expression of claudin-1 in perineurial cells and suggests a role for claudin-1 immunohistochemistry in the diagnosis of perineuriomas. Although claudin-1 should not replace EMA in the diagnosis of perineurioma, we think that it may play a valuable adjunctive role in difficult cases. In particular, claudin-1 is often a more robust marker than EMA in a given perineurioma. Claudin-1 is not expressed within the lesional cells of the mesenchymal tumors that enter into the differential diagnosis of perineurioma.

Biomarkers, Tumor↗

PubMed2003

Protein gene product 9.5 (PGP 9.5) is not a specific marker of neural and nerve sheath tumors: an immunohistochemical study of 95 mesenchymal neoplasms.

In non-neoplastic tissues, the expression of protein gene product 9.5 (PGP 9.5), a member of the ubiquitin hydrolase family of proteins, is confined to neural and neuroendocrine cells. Although it has been claimed that PGP 9.5 is a specific marker of neural and/or nerve sheath differentiation in human tumors, careful review of the literature suggests that relatively few nonneural or nerve sheath tumors have been studied. Prompted by our recent observation of a PGP 9.5-positive malignant fibrous histiocytoma, we undertook a study of PGP 9.5 expression in a large group of well-characterized mesenchymal neoplasms. Sections from 95 mesenchymal tumors were retrieved from our archives and immunostained for PGP 9.5 using standard avidin-biotin complex technique and heat-induced epitope retrieval. Scoring was as follows: negative, 1+ (<10-25% of cells), 2+ (25-50% of cells), and 3+ (>50% of cells). Normal nerves and fibrous tissue were internal positive and negative controls, respectively. Positive immunostaining was seen in 80/95 (84%) of cases. Positive results by tumor subtype were as follows: (1) nerve sheath tumors: malignant peripheral nerve sheath tumor (7/10), neurofibromas (10/10), and perineuriomas (3/3); (2) (Myo) fibroblastic tumors: malignant fibrous histiocytoma (18/20), low-grade fibromyxoid sarcomas (8/9), fibromatoses (7/7), and desmoplastic fibroblastomas (2/2); (3) vascular tumors: angiosarcomas (4/4), hemangioendotheliomas (3/5), and hemangiomas (3/4); and (4) other non-nerve sheath tumors: pleomorphic liposarcoma (4/4), dermatofibrosarcoma protuberans (2/5), rhabdomyosarcomas (2/2), synovial sarcomas (8/8), melanomas (1/2). All positive cases were 2-3+ except 6 malignant peripheral nerve sheath tumor, 1 neurofibroma, 3 malignant fibrous histiocytoma, 2 low-grade fibromyxoid sarcoma, and 1 dermatofibrosarcoma protuberans. Positive staining was seen in normal smooth muscle and germinal centers in addition to nerves. We conclude that in this, the largest study to date of PGP 9.5 expression in mesenchymal neoplasms, we have found strong (2-3+) expression in the vast majority of nonneural or nerve sheath neoplasms studied. Although PGP 9.5 is a sensitive neural/nerve sheath marker, it is essentially totally nonspecific for diagnostic purposes. It is possible that our findings reflect cross-reactivity of the 13C4 clone with epitopes present on other ubiquitin hydrolases. Alternatively, PGP 9.5 expression may be aberrantly up-regulated in a variety of mesenchymal neoplasms.

Biomarkers, Tumor↗

PubMed1982

Immunohistochemical observation of intracytoplasmic lysozyme in proliferative and neoplastic fibrohistiocytic lesions.

Distribution of intracytoplasmic lysozyme in proliferative and neoplastic fibrohistiocytic lesions and non fibrohistiocytic tumors was studied by immunoperoxidase technique on formalin fixed, paraffin-embedded sections. The cases examined were 161 fibrohistiocytic lesions and 86 non-fibrohistiocytic tumors. Contrary to our expectation, the lysozyme positive cells were found only in the minority of cases with fibrohistiocytic lesions. Cells positive for lysozyme were found only in 13 out of 100 cases of dermatofibroma, one out of 4 cases of xanthogranuloma and 8 out of 33 cases of malignant fibrous histiocytoma. Dermatofibrosarcoma protuberans and non-fibrohistiocytic tumors were negative for lysozyme. It is suggested that in proliferative fibrohistiocytic lesions, induction of lysozyme synthesis is weak or absent. Some malignant fibrous histiocytomas showed scattered lysozyme positive neoplastic cells, indicating their probable histiocytic origin or differentiation. On the other hand, evidence of histiocytic differentiation of dermatofibrosarcoma protuberans was not obtained using lysozyme immunohistiochemistry.

Aged↗

PubMed1995

Assessment of diagnostic utility of anti-CD34 in soft tissue tumors.

We have performed this study to define the usefulness of an anti-human progenitor cell antigen-1(anti-CD34) to distinguish some kinds of soft tissue tumors in formalin-fixed, paraffin-embedded tissues. Sixty three cases of vascular, fibrohistiocytic, neural and other tumors were immunostained for CD34 using the streptavidin-biotin immunoperoxidase method. All of the vascular tumors including hemangiomas, epithelioid hemangioendotheliomas, hemangiopericytomas, and lymphangiomas revealed strong CD34 positivity along the cytoplasmic membranes. Among the fibrohistiocytic lesions, all of five examples of dermatofibrosarcoma protuberans showed diffuse, strong, and linear staining along the cytoplasmic processes. In contrast, none of the benign fibrous histiocytomas and malignant fibrous histiocytomas expressed CD34. CD34-positive cells with delicate dendritic processes could be identified within the normal nerves, neuromas, neurofibromas, and Antoni B areas of neurilemomas. However, all of the malignant peripheral nerve sheath tumors were uniformly negative. In addition, an epithelioid sarcoma and four cases of leiomyosarcoma revealed focal, weak positivity with anti-CD34. In conclusion, this study demonstrated variable anti-CD34 staining pattern of certain fibrohistiocytic, muscle, and neural tumors and confirmed the potential usefulness of anti-CD34 in differentiating fibrous histiocytoma from dermatofibrosarcoma protuberans. It's also helpful to diagnose epithelioid hemangioendothelioma from other epithelioid-type tumors.

Antibodies, Monoclonal↗

PubMed1999

Expression of P53, MDM2 and Ki-67 antigens in soft tissue sarcomas.

The expression of P53 and MDM2 proteins was examined by immunohistochemistry in 115 soft-tissue sarcomas (STSs), including 32 malignant peripheral nerve sheath tumours, 27 liposarcomas, 18 leiomyosarcomas, 16 synovial sarcomas, 14 fibrosarcomas and 8 dermatofibrosarcomas, to investigate their possible association with clinicopathologic features and proliferative rate. Positivity for P53 and MDM2 was found in 9.7% and 28.1% tumours, respectively. The fraction of P53 and MDM2 positive tumours was the highest in leiomyosarcomas (16.7% and 17.2%, respectively) and the lowest in dermatofibrosarcomas (0% and 4.3%, respectively). Overall, P53(-)/MDM2(+) phenotype predominated (20.2%), while 7.9% of tumours were both P53 and MDM2 positive, and 1.8% of tumours were only P53 positive. P53 accumulation was associated with a high histological malignancy grade and a higher proliferative rate. MDM2 immunoreactivity was revealed in tumours of all malignancy grades and there was no association between MDM2 positivity and tumours proliferative activity. These results suggest that P53 overexpression underlays rather late events in the oncogenesis of STSs, which might be a determinant of their proliferative rate. In contrast, MDM2 deregulation seems to be an early rather than a late event in STSs, which may occur without involving stabilization and inactivation of P53 gene.

Adult↗

PubMed1990

[Ultrastructural study of fibrosarcoma].

Ultrastructure of 9 cases of fibrosarcoma was observed and compared with that of fibrous connective tissue of 4 human embryos and 9 cases of spindle cell sarcoma, including 3 each of leiomyosarcoma, neurofibrosarcoma and dermatofibrosarcoma protuberans. Ultrastructurally, fibrosarcoma consisted of well-differentiated fibroblast-like cells, poorly differentiated fibroblast-like cells (embryonic fibroblast-like cells), myofibroblast-like cells and primitive mesenchymal cells. It is suggested that fibrosarcoma may arise from primitive mesenchymal cells which are capable of differentiating into fibroblast and myofibroblast. There were two special cases of fibrosarcoma in this series. One was a congenital fibrosarcoma with ultrastructure resembling adult and the other was a sarcoma of myofibroblast. Diagnosis and differential diagnosis between fibrosarcoma and leiomyosarcoma, neurofibrosarcoma, dermatofibrosarcoma protuberans are discussed.

Adolescent↗

PubMed1982

[Histogenesis of storiform tumors (an electron microscopy study)].

The question of histogenetic relations between storiform tumours led to electron-optic revision of 29 skin histiocytomas, 10 sclerosing hemangiomas, 13 lenticular dermatofibromas and 10 protuberant dermatofibrosarcomas. Endothelia and pericytes with numerous transient formations, together with various degrees of lipid or some other accumulation on the one hand and fibroproduction tied up with the lateral membrane on the other, were found in all in varying degrees. The filamentous component of tumorous cells had always the properties of myofibrils with a tendency to brushlike formations dependent on the cellular membrane which usually contained numerous pinocytotic vacuoles. It thus differed from the cells of storiform neurofibromas (4 cases), whose intracytoplasmatic filaments showed no tendency to clustering or relation to the cellular membrane. Moreover, in their finer lateral membrane no substantial production of collagenous fibers occurred. According to the results of the study, histiocytoma, sclerosing hemangioma and dermatofibroma belong to the same category of tumours from mixed vasoforming tissue. Of the same, but mostly hemangiopericytary, origin is probably also protuberant dermatofibrosarcoma provided it is histogenetically uniform. Storiform neurofibroma is structurally different.

Fibroma↗

PubMed1977

[Enzyme patterns in connective tissue proliferations (author's transl)].

In a series of benign or semimalignant connective tissue proliferations (4 desmoids, 1 recurrence of a dermatofibrosarcoma protuberans, 4 fibromas, 1 neurofibroma, 3 keloids, 3 Dupuytren's contractures) and a normal fascia for comparison the pattern of 18 enzymes from different metabolic pathways was investigated. It should be clarified whether alterations of the enzyme pattern wouldoccur, asthey are found in malignant tumours. The activity of most of the enzymes investigated increased about twofold in the latter of two extirpations (16 months interval) of a recurring desmoid. In the recurrence of a dermatofibrosarcoma protuberans and in a recurrance of a fibroma a remarkably high activity of glucose-6-phosphate dehydrogenase and pyruvate kinase was found. High activities of these enzymes are known to be characteristic of experimental tumours of animals and human malignant neoplasms. Therefore it is assumed that these differences from the normal patternof enzyme activity are related to recidivity and may be regarded as first signs of a deviation from benignity. Based on these results further studies haveto be done with the aim to find a biochemical tool for, evaluation and prognosis of the course of these diseases.

Dupuytren Contracture↗

PubMed2001

Soft tissue tumors of the abdominal wall: analysis of disease patterns and treatment.

HYPOTHESIS: Abdominal wall tumors, though clinically similar, have varying degrees of biological behavior. DESIGN: Retrospective review of prospective databases. SETTING: Memorial Sloan-Kettering Cancer Center. PATIENTS: Eighty-five patients with abdominal wall soft tissue tumors. MAIN OUTCOME MEASURES: Primary endpoints included time to first local recurrence, distant metastases, and disease-related mortality. Survival analysis was performed by Kaplan-Meier method, and comparisons were made by log-rank analysis. RESULTS: Thirty-nine desmoids, 32 soft tissue sarcomas (STS), and 14 dermatofibrosarcoma protuberans (DFSP) underwent surgery directed at achieving margin-negative resection. Unlike DFSP, most STS (77%) and desmoids(87%) were deep lesions requiring full-thickness abdominal wall resection and mesh reconstruction. Median follow-up time was 53 months, 101 months, and 31 months, with 5-year local recurrence-free survival rates of 97%, 100%, and 75%, for desmoids, DFSP, and STS, respectively. Desmoid tumors resected with positive microscopic margins had higher local failure rates (68% [positive margin] vs 100% [negative margin] 5-yr local recurrence-free survival, P<.05). For STS, high grade, deep location, and size at or above 5 cm were adverse prognostic factors for disease-specific and distant recurrence-free survival (P<.05); patients experiencing local recurrence was associated with decreased 5-year relapse-free survival rates (87% [primary] vs 50% [local recurrence], P<.05). Characteristically, no DFSP or desmoid developed distant metastases. Soft tissue sarcomas had significantly lower relapse-free survival rates than DFSP or desmoids (P<.05). CONCLUSION: Abdominal wall tumors demonstrate a broad spectrum of biological behavior. Desmoids and DFSP are a local problem. High grade, size at or above 5 cm, and deep location predict distant failure and tumor-related mortality for patients with STS. Complete surgical resection is the recommended treatment approach to achieve local control. Stratification by prognostic factors will facilitate selection of patients with STS for adjuvant systemic therapies.

Abdominal Muscles↗

PubMed2001

Growth-inhibitory effect of STI571 on cells transformed by the COL1A1/PDGFB rearrangement.

Dermatofibrosarcoma protuberans (DP) is a skin tumor of intermediate malignancy characterized by high recurrence rates, for which surgical excision is the main therapy. All DP cases carry a specific t(17;22) translocation, resulting in a COL1A1/PDGFB rearrangement. The subsequently deregulated production of PDGFB generates autocrine stimulation of PDGFrbeta, leading to malignant transformation. Using NIH-3T3 cells transformed by the COL1A1/PDGFB rearrangement (5A cell line), we explored the possibility of blocking the PDGFB autocrine loop, both in vitro and in vivo, using STI571, an inhibitor of the PDGF receptor and of ABL kinase activity. The presence of small amounts of serum in the culture medium was required for the in vitro growth and morphological transformation of 5A cells. In the presence of STI571, the growth rate was reduced and the associated transformed phenotype changed to a flattened one. This effect could be reversed on removal of the inhibitor. The growth rate of tumors induced by 5A cells in nude mice was reduced by STI571 administration. Interestingly, this effect was also evident on pre-existing tumors, but no tumor eradication was observed. This is consistent with the reversible effects of the inhibitor observed in vitro but differs from the eradication effect of STI571 on BCR-ABL-induced tumors. Our data indicate that STI571 might be a candidate compound for the pharmacological treatment of DP and demonstrate that the same compound may act in different ways (cytotoxic vs. cytostatic), according to the specificity of the inhibited tyrosine kinase, namely, ABL or PDGFrbeta.

3T3 Cells↗

PubMed2002

Resection of soft tissue sarcomas with intra-operative magnetic resonance guidance.

PURPOSE: To report on a preliminary series of magnetic resonance (MR)-guided sarcoma resections. MATERIALS AND METHODS: Three patients with the skin sarcoma dermatofibrosarcoma protuberans underwent MR-guided resection. RESULTS: The extent of the tumor at MR imaging was greater in each case than suggested by clinical examination. Adequate resection margins were planned using short Tau inversion recovery (STIR) sequences and intra-operative imaging was used to confirm complete tumor excision. Histological examination confirmed clear surgical margins of at least 1 cm in each case. CONCLUSION: We believe this technique may reduce the incidence of specimen margins positive for tumor following resection, and consequently reduce the need for further excisional surgery.

Adult↗

PubMed2003

Giant cell fibroblastoma in a 3-year-old boy.

Giant cell fibroblastoma (GCF) is a rare soft tissue tumor most often discovered during the first two decades of life. We present a case of a 3-year-old boy with a history of a recurrent lesion in the knee, the tumor growth progressively and enlarged to 2.1 cm in the previous two years before diagnosis. It involved the subcutaneous tissue, had infiltrative borders and extended into the superficial dermis. The tumor was surgically excised with free margins. There was no evidence of local recurrence, and a metastatic workup was negative after 10 years of follow up. We review herein the clinicopathologic features, histogenesis, differential diagnosis and relationship to dermatofibrosarcoma protuberans (DFSP).

Child, Preschool↗

PubMed1996

[CD34 detection--an immunohistochemical contribution to differential diagnosis of soft tissue tumors].

CD34 is a myeloid progenitor cel antigen and present in endothelial cells and almost all vascular lesions. Additionally, CD34 has been described in numerous fibroblast-like cells and different mesenchymal tumours. The immunohistochemical evidence of CD34, however, may be of importance in the differential diagnosis of benign and malignant soft tissue lesions, if clinicopathological features and other immunohistochemical markers are regarded properly. We studied the CD34 immunopositivity of solitary fibrous tumour at different sites (11 out of 11 tumours tested stained positive), dermatofibrosarcoma protuberans (15 out of 18 stained positive), and gastrointestinal stromal tumour (15 out of 15 stained positive), and discuss the significance of these results in differential diagnosis to morphologically comparable soft tissue lesions.

Adolescent↗

PubMed2004

Management of sarcomas of the head and neck.

Soft tissue and bone sarcomas in the head and neck are rare tumors. The 1000 to 1500 yearly cases in the United States are distributed among at least 10 main histologies and multiple head and neck subsites. Although this makes structured studies difficult to perform and high-level evidence-based treatment algorithms difficult to find, basic treatment recommendations can be made from the existing literature for most histologies and subsites. This paper discusses the epidemiology, natural history, and treatment approaches for several of the most common head and neck sarcomas, including the "adult soft tissue sarcomas," osteosarcoma, chondrosarcoma of the larynx, angiosarcoma, rhabdomyosarcoma, desmoid tumors, and dermatofibrosarcoma protuberans.

Chondrosarcoma↗

PubMed2006

Reconstruction of large thoracoabdominal defects using two-stage free tissue transfers and prosthetic materials.

Very large full thickness defects of the thorax or abdomen after tumoral resections commonly need to be reconstructed with free tissue transfers. We retrospectively analysed the protocol of performing the free tissue transfer before the wide excision in 15 patients (mean age of 48) with large tumours of the thorax and abdomen. During the first stage, the flap was folded on itself in a strategic position close to the future resection site and microsurgical anastomoses performed. The second stage surgery consisted of the full thickness excision and definitive reconstruction of the defect by unfolding the flap over prosthetic material. The inclusion criteria were: large thoracoabdominal resections exposing lung or bowel and requiring the use of prosthetic material as part of the reconstruction after resection for locally aggressive tumours such as dermatofibrosarcoma protuberans. In 8/10 patients, vein grafts were used in the arterial anastomosis. The mean time interval between the first and the second stage was 17 days (7-50 days). Flap survival was one hundred percent on first attempt. In one patient who had presented with a large abdominal haemangioma, pulmonary embolism occurred during the second stage. In another patient, an infection under the flap occurred 3 years after reconstruction. Results of this series of patients support our belief that a two-stage microsurgical strategy can be useful in selected patients where large free flaps (with grafted pedicle) in combination with prosthetic materials have to be performed for reconstruction of full thickness defects of the trunk or the abdomen.

Abdominal Wall↗

PubMed2006

The versatility of the inter-costal artery perforator (ICAP) flaps.

INTRODUCTION: Anatomy and classification of intercostal perforator flaps in addition to our experience with will be demonstrated for different indications. MATERIAL AND METHODS: The intercostal vessels form an arcade between the aorta and the internal mammary vessels. Different pedicled perforator flaps can be raised on this neurovascular bundle to cover defects on the trunk. They are classified as following: dorsal intercostal artery perforator flap (DICAP); lateral intercostal artery perforator (LICAP); and anterior intercostal artery perforator (AICAP) flap. RESULTS: Between 2001 and 2004, 20 pedicled (ICAP) flaps were harvested in 16 patients. The indications were: immediate partial breast reconstruction in eight patients who had a quadrantectomy for breast cancer; midline back and sternal defects in three patients who had radical excisions for a dermatofibrosarcoma or malignant melanoma; and autologous breast augmentation (four bilateral and one unilateral flap) in five post-bariatric-surgery patients. The average flap dimension was 18 x 8 cm(2) (range 8 x 5-24 x 12 cm(2)). There were two DICAP flaps, two (AICAP) flaps and 16 (LICAP) flaps. All but two flaps were based on one perforator. Mean harvesting time was 45min for a single flap. Bilateral breast augmentation with LICAP flap necessitated longer operative time (range 2-3h) depending whether it was combined or not with mastopoexy. Complete flaps survival was obtained. All donor sites were closed primarily. CONCLUSION: The (ICAP) flaps provide valuable options in breast surgery; and for challenging defects on the trunk without sacrifice of the underlying muscle.

Adolescent↗