Widespread cutaneous angiosarcoma of the scalp: diagnosis and soft tissue reconstruction with a combined double-muscle-free flap and split-thickness-skin graft

Abstract

Cutaneous angiosarcoma is a rare vascular tumor, which is usually located in the head and neck region. Because of the unspecific appearance, diagnoses are only secured after a histological examination of a tissue sample. After three punch biopsies, a 67-year-old patient, who had been healthy so far, was diagnosed with a cutaneous multilocated angiosarcoma of the scalp. Computed tomography of the head, neck, thorax, and abdomen was done for staging. It was without pathological findings. The tumor removal caused a scalp defect with a size of 30 x 30 cm. The cover of the defect was made by a combined microsurgical muscle flap with parts of the musculus latissimus dorsi and musculus serratus anterior. This flap was covered with split-thickness-skin in a second step. Eight weeks postoperative, the radiotherapy has started. This kind of treatment can be recommended because the early reconstruction allowed a soon adjuvant radiotherapy, and the patient regained a good quality of life due to the pleasant and aesthetically result.