Synovial sarcoma of the abdominal wall with two-stage laced free latissimus dorsi reconstruction of a full-thickness defect: a case report and literature review

Abstract

BACKGROUND: Sarcomas of the trunk and abdominal wall are rare and present unique challenges in both resection with free margins and reconstruction, particularly when the tissue loss is extensive. These tumors predominantly affect young, active individuals, posing a significant challenge for oncologists and plastic surgeons in preserving the patients' quality of life. CASE PRESENTATION: We present the case of 23-year-old woman with no significant medical history. She was initially treated at a nonexpert center for a monophasic synovial sarcoma of the abdominal wall. After undergoing three lines of chemotherapy with no response, she was referred to our department, a sarcoma expert center, for debulking surgery in October 2020. Physical examination revealed a large, firm, and painful subcutaneous mass located in the left iliac fossa, extending into the flank. This mass was beneath a linear scar from prior enucleation surgery and measured approximately 25 cm. A full body CT scan confirmed that the mass was attached to the anterior abdominal wall, with no evidence of invasion into internal abdominal organs or metastatic spread. Because of the large size of the tumor and the consequent full-thickness defect of the anterior abdominal wall, surgical resectability depends on the success of the reconstructive surgery. Given the large tumor size and resulting full-thickness defect of the abdominal wall, the success of the surgical resection heavily relies on the effectiveness of the reconstructive surgery. We successfully performed a two-stage intervention, starting with a laced latissimus dorsi (LD) free flap transfer, followed by oncological resection seven days later. While this technique has been described for head and neck reconstruction, it is, to our knowledge, the first reported use in abdominal wall reconstruction. CONCLUSIONS: Surgical resection remains the cornerstone of treatment for synovial sarcoma, and the extent of resection should not be limited by concerns about defect restoration. The free latissimus dorsi flap, when utilized with careful surgical planning, is an effective option for reconstructing complex abdominal wall defects. This case highlights the importance of advanced reconstructive techniques in ensuring both oncological control and the preservation of the patient quality of life.