Interdisciplinary Treatment for Cutaneous Abdominal Wall Metastasis from Cervical Cancer with Resection and Reconstruction of the Abdominal Wall-Using Free Latissimus Dorsi Muscle Flap: A Case Report

摘要

Despite extensive screening and a significant increase in the numbers of diagnosed and treated precancerous lesions, cervical cancer is the second most common cancer in women. Screening programs have resulted in a drop in the number of women newly diagnosed with cervical cancer every year, and many tumors are detected in their early stages [1 ]. Vaccinations against different human papilloma viruses only became generally available a few years ago, and most women between the age of 30 and 40 years have therefore not benefitted from the protection afforded by vaccination [2]. Early lymphatic metastasis often occurs in the parametrium and the pelvic lymph nodes. Hematogenous dissemination tends to occur relatively late and commonly involves the liver, lungs and skeleton [3]. Cutaneous metastases are found in fewer than 2% of patients and are usually associated with a poor prognosis [4]. Straightforward plastic surgery with reconstruction using advancement or rotation flaps obtained from the area around the defect are unsuitable in these cases because the recipient site has been treated with radiotherapy, which is likely to increase the problem. Microsurgical free-tissue transfer uses healthy, non-irradiated, well-vascu-larized tissue. There are very few reports of abdominal wall recurrence of the type described here, and their treatment, particularly if local flap plasty results in further skin and soft-tissue defects, represents a challenge for an interdisciplinary team of gynecologists and general and plastic surgeons. In addition to covering the defect, the aim of surgery is either to preserve the prosthetic mesh required for stabilization or to create an alternative means of stabilization. The treatment algorithm used in this interdisciplinary approach is described for a patient with this rare recurrence.