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Background: To present a single-institution experience in the comprehensive and global soft-tissue surgical approach of patients with craniofacial neurofibromatosis type 1 (NF-1)., Methods: A retrospective analysis of patients with craniofacial NF-1 (n = 20) who underwent craniofacial soft-tissue reconstruction between 1993 and 2014 was conducted. Surgical treatment was individualized according to age, functional and/or aesthetic impairment, neurofibroma types, anatomical location, size, and patient/family and surgical team preferences, regardless of previously published compartmental grading systems. The surgical results were classified based on 2 previously published outcome rating scales (craniofacial symmetry improvement and need for additional surgery)., Results: All patients underwent en bloc translesional surgical excisions, 12 facial suspension, 3 eyebrow suspension, 2 ear suspension, 9 lateral canthopexy, 5 horizontal shortening of the tarsus of lower eyelid, and 1 horizontal shortening of the tarsus of upper eyelid. The degree of craniofacial symmetry improvement was considered "mostly satisfactory" (75%), and the overall rate of surgical results ranked according to the need for additional surgery was 2.4 ± 0.50, with variations according to the spectrum of soft-tissue involvement., Conclusions: According to the experience and surgical outcomes presented in this study, the soft-tissue surgical approach of the craniofacial NF-1 should be global, comprehensive, and individualized.

Background: Neurofibromatosis type 1 (NF-1) is a locally invasive tumor that can grow extensively with diffuse infiltration into surrounding tissue. Resecting a large neurofibroma can result in an extensive defect that is difficult to reconstruct and can cause both aesthetic and functional deformities., Methods: From 2000 to 2010, 5 patients with NF-1 underwent radical resection and immediate reconstruction with 6 free flaps at our institution. All patients presented with recurrent tumor, and involved head and neck region in 4 and foot in 1 patient. Ages ranged from 18 to 75 years. The follow-up ranged from 1 to 94 months., Results: Defect sizes ranged from 84 to 252 cm. A single free flap was used in 4 cases and 2 free flaps were used in 1 case. All the flaps survived. Complications included loss of skin graft, necrosis of the distal tip of a flap, and wound dehiscence. All complications were successfully managed with minor surgical procedures., Conclusion: Immediate reconstruction using a free flap after resecting a large neurofibroma is a safe and reliable method that facilitates radical resection of the tumors that are difficult to resect and that may result in an extensive defect.

The objective of this review article is to summarize the published details and media citations for all seven face transplants performed to date to point out deficiencies in those reports so as to provide the basis for examining where the field of face transplantation stands, and to act as a stimulus to enhance the quality of future reports and functional outcomes. Overall long-term function of facial alloflaps has been reported satisfactorily in all seven cases. Sensory recovery ranges between 3 and 6 months, and acceptable motor recovery ranges between 9 and 12 months. The risks and benefits of facial composite tissue allotransplantation, which involves mandatory lifelong immunosuppression analogous to kidney transplants, should be deliberated by each institution's multidisciplinary face transplant team. Face transplantation has been shown thus far to be a viable option in some patients suffering severe facial deficits which are not amenable to modern-day reconstructive technique.

Two patients with severely deforming giant neurofibromatosis of the chest wall secondary to von Recklinghausen's disease are presented. Pain, respiratory compromise, recurrent ulcerations, cosmetic considerations, and the malignant potential of these lesions indicated wide excision and reconstruction. It is impossible to completely eradicate all neurofibromas, which may affect virtually every nerve within the chest wall including the mediastinum. However, excision of the primary mass may reduce the possibility of malignant degeneration into neurofibrosarcoma or malignant schwannoma. This type of major, full-thickness chest wall resection is now possible using musculocutaneous flaps to achieve satisfactory closure with a single-stage procedure with minimal morbidity and a short hospital stay. At the 10-year follow-up, neither patient exhibited evidence of recurrence.

Neurofibromatosis type 1 (von Recklinghausen's disease or peripheral neurofibromatosis) is of particular interest to the plastic surgeon, as it affects the skin. The majority of affected patients require operative procedures for cosmetic and functional reasons. Rarely, vascular lesions such as stenosis, rupture of an aneurysm, and fistula formation in neurofibromatosis type 1 can create some difficulties during operation without any symptoms before surgery. We report the management of a large occipitojugular fistula. This life-threatening fistula was located on the right side of the face of a 28-year-old patient who had been operated six times for the same neurofibromatous mass without any operative complications. During the operation for partial excision of the neurofibromatous mass, life-threatening, uncontrollable hemorrhage began and the operation was ended without excision. Postoperative angiography revealed an arteriovenous fistula between the occipital artery and jugular vein, and also total occlusion/agenesis in the postclinoid cisternal segment of the internal carotid artery. The fistula was obliterated with coil and histoacryl lipiodol mixture. After this procedure partial excision was performed without abnormal bleeding.

The CO2 laser is presented as a useful tool for the removal of large numbers of neurofibromas, the major source of cosmetic disfigurement in the patient with peripheral neurofibromatosis. Its advantages include high patient satisfaction with the rapid, staged removal of thousands of neurofibromas, with minimal morbidity and an enhanced appearance. The operative technique for each of the forms of neurofibroma, that is, pedunculated, sessile, and subcutaneous, is described. As with all procedures involving a change in appearance, it is essential that the patient be fully aware of the limitations of the procedure and the expected final result. This is easily accomplished in this procedure by the use of a "test treatment."

This assessment of a new hemostatic scalpel in plastic surgery is based on one surgeon's personal experience with this instrument in 348 cases representing a variety of procedures. With its improved hemostatic capabilities the hemostatic scalpel may offer the following advantages: better visualization of the surgical field, enhanced precision, and more delicate control. Considerable time and experience are necessary, however, before the scalpel can be used safely and competently.

Neurofibromas are common tumors that arise from elements in the peripheral nervous system. The vast majority occur in the trunk and are usually limited to the head and neck area. We present two cases involving the skin of the breast and nipple-areolar complex and the method of treatment.

Neurofibromatosis is a rare inherited disease that may present as facial hamartoma or as a more generalized disease with subcutaneous tumors, skin pigmentation in the form of café-au-lait patches, and multiple pedunculated neurofibromas on a narrow skin base. The generalized form of the disease is named after von Recklinghausen, who described its main features in 1882. In this paper, we restrict ourselves to a discussion of the craniofacial manifestation of the disorder and also report our experience in treating 2 patients with orbitofacial neurofibromatosis at the Rambam Medical Center in Haifa.

A case of left facial elephantiasis neurofibromatosa was treated with near-total excision and skin graft. Results were favorable. Repositioning of canthal ligaments, preserving part of relatively normal masseter muscle and primary nasal reconstruction with forehead flap were performed. The skin graft over the myxomatous muscle was successful. Troublesome bleeding was avoided or controlled by incising the normal skin, subperiosteal dissection, hypotensive anesthesia, and chromic catgut suture ligature.