Wide surgical excision and directed healing in forearm Leiomyosarcoma: Case report

Background:  Leiomyosarcoma is a rare malignant tumor originating from smooth muscle cells and represents a small subset of soft‑tissue sarcomas. Standard treatment relies on wide surgical excision with negative margins. However, oncologic resections may lead to extensive soft‑tissue defects requiring complex reconstruction. Directed secondary intention healing remains an underreported yet valuable option in selected clinical scenarios.

Case Presentation: We report the case of a 63‑year‑old woman presenting with a slowly enlarging multilobulated tumor of the ulnar border of the right forearm evolving over five years. Histopathological analysis confirmed a well‑differentiated leiomyosarcoma. After multidisciplinary discussion, wide surgical excision was performed, resulting in a large musculo‑cutaneous defect measuring approximately 20 cm. Directed healing with daily dressing changes and close monitoring was adopted.

Results:  Progressive granulation tissue formation and epithelialization occurred over several weeks. At four months follow‑up, complete coverage was obtained with a stable, trophic and sensitive scar.

Conclusion: Directed healing represents a simple, safe and cost‑effective strategy for selected large post‑oncologic defects when immediate reconstruction is not mandatory.