Recurrent giant neurofibroma of the posterior neck and upper back with failed primary grafting and salvage reconstruction: a case report.

BACKGROUND: Giant or recurrent neurofibromas associated with neurofibromatosis type 1 (NF1) may mimic vascular tumors and create large reconstructive defects, particularly in mobile regions. We report a recurrent posterior neck and upper-back neurofibroma with failure of primary grafting and subsequent salvage reconstruction.

CASE PRESENTATION: A 23-year-old woman had previously undergone an aborted operation for a lesion diagnosed as hemangioma; postoperative pathology showed neurofibroma. The recurrent mass was excised along the superficial aspect of the deep fascia with an estimated blood loss of approximately 100 mL, leaving a defect involving about 7% of total body surface area. A split-thickness graft harvested from clinically preserved skin overlying the tumor failed after subgraft seroma formation and Klebsiella pneumoniae infection, with approximately 20% graft take. Salvage treatment consisted of repeat debridement, culture-directed infection control, a 1:3 meshed split-thickness graft from the thigh, negative-pressure wound therapy adapted into separate neck and back dressing zones, and postoperative immobilization. Graft take was complete. At 6 months, no recurrence was detected, neck motion was preserved, the Vancouver Scar Scale score was 3, and the Neck Disability Index score was 5.

CONCLUSIONS: This case emphasizes accurate diagnosis, careful selection of graft donor skin, adequate wound-bed preparation, infection control, secure graft fixation, and immobilization in a high-mobility region. Dividing the negative-pressure dressing into separate zones was a practical modification for this wound rather than a novel reconstructive principle, and broader recommendations cannot be made from a single case.