A 41-year-old male patient presented with recurrent tumoral lesions on the left side of the base of the neck, 10 cm in diameter, with a central ulcerated area, bleeding, and adhered to deep planes.
It presents a 30-year evolution and diagnosis of solitary neurofibroma, so it was treated three times with partial resections and coverage with acromial flap and graft.
He developed a retractile keloid scar in the left lateral neck area and was treated with 15 radiotherapy sessions, which caused an important limitation for lateral movements of the cervical area.
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We proceeded to perform an imaging study of the lesion using magnetic resonance imaging with coronal and sagittal axial sections in Fast Spin Eco sequence, potentiated in T1, T2, GRE and T1 longitudinal axis well-defined neck solid cm insertion area.
No involvement of vascular structures of the neck or intrathoracic extension was observed.
After gadolinium administration, moderate tumor enhancement was observed.
The patient underwent surgery in conjunction with plastic surgery and restorative surgery, performing preoperative marking for complete resection of the neurofibroma and immediate reconstruction.
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Ongoing block resection of the neurofibroma was performed by the on-line team, generating a blade tissue defect of 20x10 cm in diameter with exposure to the clavicle area of the left first rib and medial area.
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The Plastic Surgery team was in charge of restoring the defect by subfascial dissection, with magnifying glasses 2.5 x, of a free flap of anterolateral thigh of the left circumflex branch of the femoral artery 12 cm.
The donor area of the anterolateral thigh flap was closed by first intention without complications.
The coordination of work in two teams by Ontario and Plastic Surgery, facilitated the total operative time to be 5 hours, not accepting the patient transfusions or stay in the ICU
The proper planning, by locating 2 perforating vessels in the left thigh area with a manual 8 MhZ doppler, made it possible to obtain a flap with the necessary dimensions for coverage.
The histopathological report of the resection confirmed the diagnosis of neurofibroma, with dimensions of 16x10.5x6.5 cm, showing mesenchymal and surgical cells, free of Schwann cells, deep margins, lesion.
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The patient was hospitalized for 6 days, with intravenous antibiotic therapy with cefazolin 1 gr every 8 hours, acetyl salicylic acid 100 mg ketoprofen every 8 hours oral ketoprofen every 8 hours.
We did not immobilize the receiving area or donor, and we only left open Penrose drainage in the receiving area for 48 hours.
Flap monitoring was performed clinically evaluating capillary filling, color and local temperature every hour in the first 24 hours, and then every 2 hours for 48 additional hours.
We also used the 8MhZ manual doppler to assess the patency and patency of venous and arterial anastomoses.
During the hospital stay, there were no data on venous congestion or arterial insufficiency, with adequate coverage of the defect created by the resection.
Neck physiotherapy was started 6 weeks after the intervention, based on flexion-extension and lateral neck movements.
The patient was followed up in the outpatient clinic every 3 weeks for a period of 18 months, during which the neck area improved in its contour and mobility, with a better secondary aesthetic-functional result and no treatment needed.
