Case 07 2026: Reconstruction of a Complex Epigastric Abdominal Wall Defect Following Wide Excision of Giant Fibrosarcoma Using Prolene mesh and Modified Keystone Flap in a Resource-Limited Setting: A Case Report”

Abdirahman Abdifatah Mohamed; Numan Omar Ibrahim; Rose Alenyo; Kalanzi Edris

Journal of Plastic, Breast & Reconstructive Surgery·Peer-reviewed, open-access surgical case reportsPeer-reviewed · Open access

Case 07 2026: Reconstruction of a Complex Epigastric Abdominal Wall Defect Following Wide Excision of Giant Fibrosarcoma Using Prolene mesh and Modified Keystone Flap in a Resource-Limited Setting: A Case Report” · JPBRS

Case report

Case 07 2026: Reconstruction of a Complex Epigastric Abdominal Wall Defect Following Wide Excision of Giant Fibrosarcoma Using Prolene mesh and Modified Keystone Flap in a Resource-Limited Setting: A Case Report”

Abdirahman Abdifatah Mohamed, Numan Omar Ibrahim, Rose Alenyo, Kalanzi Edris

Published May 28, 2026471 views5 min read

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Abstract

Fibrosarcoma is a rare soft tissue sarcoma with aggressive local infiltration and high recurrence risk. We present a 71-year-old Ugandan man with a giant epigastric fibrosarcoma causing a complex abdominal wall defect. Imaging showed invasion of subcutaneous tissue and rectus muscle without metastasis. The patient underwent wide local excision with 5 cm margins, followed by reconstruction using Prolene mesh and a modified keystone flap with skin grafting. Recovery was uneventful, demonstrating effective surgical and reconstructive management in a resource-limited setting. Patient medical history a 71-year-old male who presented with a two-year history of a progressively enlarging anterior abdominal wall mass. The lesion initially appeared as a small, firm nodule and gradually increased in size, eventually becoming a large, fungating tumor associated with ulceration, necrosis, and intermittent bleeding. There was no history of distant symptoms suggestive of metastasis. Imaging confirmed a locally invasive epigastric mass involving the subcutaneous tissue and rectus abdominis muscle, without visceral or distant spread. Before and After Patient examination On physical examination, the patient had a large, exophytic, fungating mass located in the supraumbilical (epigastric) region of the anterior abdominal wall. The lesion was deeply invasive with irregular margins and was associated with ulceration, areas of necrosis, and active bleeding. The overlying skin was stretched, tense, and partially ulcerated. The mass appeared fixed to the underlying abdominal wall musculature, suggesting muscle involvement. There were no clinical signs of peritoneal invo

Key learning points

Pearls

Early recognition and wide local excision reduce recurrence
Mesh with modified keystone flap offers reliable
cost effective abdominal wall reconstruction without microsurgery
meticulous flap design and postoperative care optimize outcomes
Due to Limited Fibrosarcoma cases recourses in Africa journals this will be advantage and great reference.

Pitfalls

Delayed presentation
limited imaging access
and inadequate postoperative monitoring increase risk of complications and flap failure
poor planning can compromise structural and cosmetic results.

Hadley GP. Management of soft tissue sarcomas in sub Saharan Africa. S Afr J Surg.Lukande RL Wabinga HR Tumwine LK. Soft tissue sarcomas in Uganda a histopathologic appraisal

Patient history

a 71-year-old male who presented with a two-year history of a progressively enlarging anterior abdominal wall mass. The lesion initially appeared as a small, firm nodule and gradually increased in size, eventually becoming a large, fungating tumor associated with ulceration, necrosis, and intermittent bleeding. There was no history of distant symptoms suggestive of metastasis. Imaging confirmed a locally invasive epigastric mass involving the subcutaneous tissue and rectus abdominis muscle, without visceral or distant spread.

Examination

On physical examination, the patient had a large, exophytic, fungating mass located in the supraumbilical (epigastric) region of the anterior abdominal wall. The lesion was deeply invasive with irregular margins and was associated with ulceration, areas of necrosis, and active bleeding. The overlying skin was stretched, tense, and partially ulcerated. The mass appeared fixed to the underlying abdominal wall musculature, suggesting muscle involvement. There were no clinical signs of peritoneal involvement, distant metastasis, or regional lymphadenopathy.

Pre-operative considerations

Pre-operative evaluation focused on accurate staging operability and reconstructive planning.
A contrast enhanced CT scan of the abdomen was performed to assess tumor size depth and involvement of the abdominal wall confirming invasion of the subcutaneous tissue and rectus abdominis muscle without peritoneal visceral bony or distant metastatic disease.
Histological diagnosis of fibrosarcoma was established.
The case was reviewed by a multidisciplinary team to determine oncologic margins and reconstruction strategy.
The patient age
nutritional status
comorbidities
and anesthetic fitness were assessed.
Given the anticipated full thickness abdominal wall defect availability of prosthetic mesh and local flap options suitable for a resource limited setting

Step 1 — preop excision margins

Fibrosarcoma is recommended 2 to 3cm excision margins due to lack of intraop frozen section we marked 5cm margins to be in safe side

References

Hadley GP. Management of soft tissue sarcomas in sub Saharan Africa. S Afr J Surg.
Lukande RL Wabinga HR Tumwine LK. Soft tissue sarcomas in Uganda a histopathologic appraisal

How to cite this article

Related cases

Case 07 2026: Reconstruction of a Complex Epigastric Abdominal Wall Defect Following Wide Excision of Giant Fibrosarcoma Using Prolene mesh and Modified Keystone Flap in a Resource-Limited Setting: A Case Report”

Abstract

Key learning points

Hadley GP. Management of soft tissue sarcomas in sub Saharan Africa. S Afr J Surg.Lukande RL Wabinga HR Tumwine LK. Soft tissue sarcomas in Uganda a histopathologic appraisal

Patient history

Examination

Pre-operative considerations

Step 1 — preop excision margins

References

Case 20 2026: Staged Excision and Delayed Primary Closure of a large Nodular Basal Cell Carcinoma of the Anterior Scalp

Case 22 2026: Superior Gluteal vessel: A rarely used recipient for free flap reconstruction of lumbosacral defects: a case report.

Case 23 2026: “Minimally Invasive Finger Amputation Using a Volar ‘Toilet seat’ Flap for Invasive Squamous Cell Carcinoma”

Step 2 — Intraop post excision

Step 3 — Intraop Flap markings

Step 4 — Intraop Flap markings

Step 5 — Intraop Raising Flap and Mesh Insertion

Post-operative plan

Pearls

Pitfalls