Surgical Strategies for Closure of Complex Posterior Trunk Defects in Myxoid Pleomorphic Liposarcoma: A Case Report and Literature Review

Myxoid pleomorphic liposarcoma (MPL) is an exceptionally rare subtype of liposarcoma characterized by an aggressive clinical course. Since its first description in 2009, fewer than a dozen cases have been reported, predominantly in pediatric populations and mediastinal locations. Reports in elderly patients and with posterior trunk involvement are exceedingly uncommon. We report the case of an 83-year-old male with a two-year history of progressive cervical-thoracic swelling, ultimately diagnosed as MPL on biopsy. Imaging revealed an 8.6 × 6.4 × 7.6 cm mass originating from the right cervico-thoracic paravertebral muscles, infiltrating trapezius, rhomboid, subscapularis, and latissimus dorsi. The patient underwent en bloc tumor excision, including paraspinal muscles and partial vertebral elements, followed by immediate reconstruction using regional rotational musculocutaneous flaps (latissimus dorsi and trapezius) performed by a combined oncologic and reconstructive surgical team. Postoperative recovery was uneventful, and the patient was discharged with preserved functional mobility and no wound complications. MPL is recognized for its high recurrence rate and poor survival. Complete surgical resection remains the cornerstone of treatment, particularly when neoadjuvant therapy is not feasible or ineffective. Reconstruction of large posterior trunk defects is technically demanding due to limited tissue elasticity and the scarcity of recipient vessels for free flaps. Regional pedicled options, including trapezius, latissimus dorsi, and paraspinous flaps, remain reliable strategies. This case emphasizes the feasibility of achieving both oncologic clearance and functional coverage in elderly patients with extensive defects. This case highlights the rarity of MPL in advanced age and posterior trunk location, underscoring the critical role of individualized reconstructive planning. Regional pedicled flaps provide safe and effective coverage, ensuring functional preservation and reduced morbidity following radical resection.