Buttock Reconstruction With Hatchet-type Lumbosacral Flap After Resecting Diffuse Plexiform Neurofibroma With Methicillin Resistant infected Intratumoral Hematoma.

Diffuse plexiform neurofibroma (DPN) typically grows progressively. It can lead to disfigurement and functional impairment and carries a risk of life-threatening intratumoral hemorrhage. Here, an 85-year-old woman presented with a massive 23-cm-diameter DPN in the buttock area that began hemorrhaging after a fall. It was immediately treated with transcatheter arterial embolization, but 18 days later, the hematoma developed a methicillin-resistant (MRSA) infection. Consequently, after 5 days of anti-MRSA antibiotics, the DPN was entirely resected, and the large skin defect was covered with the hatchet-type lumbosacral flap. Intraoperative bleeding was only 200 mL. Anti-MRSA antibiotics were continued for 2 days. A seroma developed under the skin flap on postoperative day 21. It was readily treated with puncture drainage. Then, it resolved by postoperative day 39 after several single punctures performed every few days over the next 18 days. Flap necrosis was not observed. The patient was discharged 45 days after surgery. No recurrence was observed 2.5 years later. Thus, massive infected DPNs in the buttocks can be completely resected, and the resulting large defect successfully covered with the hatchet-type lumbosacral flap.