From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University, Shanghai, People's Republic of China.
Ann Plast Surg. 2020 Oct;85(4):413-418. doi: 10.1097/SAP.0000000000002250.
The management of giant neurofibroma is a challenge for clinical surgeons. Abundant malformed vessels exist in the tumor, and life-threatening hemorrhage can occur during operation. Moreover, repairing huge defects after radical resection is challenging. Hence, subtotal resection and debulking are more frequently performed than total resection. Although subtotal resection or debulking may reduce morbidity, it inevitably leads to a high rate of recurrence. In addition, subtotal resection or debulking does not decrease surgical risk; on the contrary, when operating on the tumor body, the rate of hemorrhage is much higher in case of subtotal resection and debulking than in radical resection. In this study, 9 patients with giant neurofibroma were retrospectively reviewed. The tumor size ranged from 12 × 9 cm to 60 × 70 cm. Preoperative angiography and magnetic resonance imaging scanning are performed to clarify the tumor features. All patients underwent radical resection, and in-operation blood loss ranged from 300 to 2600 mL. The resection defects were repaired by anterolateral thigh free flap in 2 patients and skin grafts in 7 patients. Partial skin necrosis occurred in 4 patients, and the necrosis area can be repaired with adjacent survived skin by changing the dressing several times. No tumor recurrence was recorded during routine follow-up (range, 12-39 months). The treatment strategy for radical resection of giant neurofibroma proves effective, and the technique of reusing the skin provides sufficient material for covering a large defect without the morbidity associated with a new donor. Thus, tumor removal and wound repair can be accomplished in one stage.
神经纤维瘤的治疗是临床外科医生面临的一个挑战。肿瘤中存在大量畸形血管，术中可能发生危及生命的出血。此外，根治性切除后巨大缺损的修复也是一个挑战。因此，次全切除和去瘤体较全切除更为常见。虽然次全切除或去瘤体可以降低发病率，但不可避免地会导致复发率增高。此外，次全切除或去瘤体并不能降低手术风险；相反，在肿瘤体上操作时，次全切除和去瘤体的出血量比根治性切除要高得多。本研究回顾性分析了 9 例巨大神经纤维瘤患者。肿瘤大小从 12×9cm 至 60×70cm 不等。术前进行血管造影和磁共振成像扫描以明确肿瘤特征。所有患者均行根治性切除术，术中出血量为 300 至 2600ml。2 例患者采用股前外侧游离皮瓣修复，7 例患者采用皮片移植修复。4 例患者出现部分皮肤坏死，通过多次更换敷料，可利用相邻存活皮肤修复坏死区域。在常规随访期间（12-39 个月）未记录到肿瘤复发。根治性切除巨大神经纤维瘤的治疗策略是有效的，并且皮瓣的再利用技术为覆盖大面积缺损提供了充足的材料，而不会增加新供区的发病率。因此，可以在一个阶段完成肿瘤切除和伤口修复。
