We would like to present a challenging case, successfully managed with a unique combination
of operative strategies, relying on basic principles. A 16-year old caucasian female
with a large cutaneous neurofibroma on the right lower limb measuring 26 × 19 cm,
presented for excision and reconstruction. A diagnosis of type 1 neurofibromatosis
was made based on the presence of a large cutaneous neurofibroma, multiple typical
neurofibromas, more than 6 large café-au-lait spots and iris hamartomas (Lisch nodules).
She had no other previous medical history and no previous surgery. Due to the size
of the defect and the need for a large pliable fasciocutaneous flap, a lower abdominal
flap was planned, however the patient's low body mass index (BMI) and lack of abdominal
tissue suggested that closure of the donor site would present a problem. Other reconstructive
options entertained in this setting included an anterolateral thigh flap, although
the donor site was considered sub-optimal, and other flaps such as the groin flap
would not have spanned the defect. A pre-expanded, bipedicled free ‘stacked’ deep
inferior epigastric artery (DIEP) flap was thus selected as the option of choice.
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Article info
Publication history
Published online: July 11, 2012
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
