EXCISION OF A CHEST WALL PLEXIFORM
NEUROFIBROMA AND CHEST WALL
RECONSTRUCTION: A CASE REPORT
1Abubakar U. (MBBS, FWACS), 2Legbo JN (MBBS, FMCS, FWACS & FICS),2 Opara AC (MBBS, FWACS), 3Sahabi SM (MBBS,
FMCPath) 4Ray B (MBBS), 4Abubakar Y (MBBS), 5Jacob J. (MBBS, MS, MCh), 6Kesieme EB (MBBS, MRCS, FWACS),
7Okonta KE (MBBS, FWACS)
1Cardiothoracic Surgery Unit, Department of Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
2Plastic Surgery Unit, Department of Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
3Department of Histopathology, Usmanu Danfodiyo University Teaching Hospital, Sokoto,Nigeria
4Department of Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
5Insttitute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India
6Department of Surgery, Irrua Specialist Hospital, Irrua, Nigeria
7Department of Surgery, University of Port Harcourt, Rivers State, Nigeria
Introduction
• Primary or metastatic chest wall tumours
infiltrate all layers
• Surgery poses technical problem
• Before any resection, careful planning of
reconstruction possibilities is mandatory
• The aim is to present our experience with
excision of a chest wall plexiform
neurofibroma and reconstruction
Case report
• 24 year old farmer
• Anterior chest wall mass and multiple truncal skin
nodules since childhood
• Mass was painless not associated respiratory
symptoms
• Skin nodules are not associated with itching
• No hearing or visual impairment
• No family history of similar problems
• O/E – wide spread subcutaneous of varying
sizes , widespread café ulait spots
• Chest wall mass measuring 16X14X8cm,
hyperpimented skin, firm – hard and fixed to
anterior chest wall
• Vesicular breath sounds bilaterally
• CXR – cortical destruction of the sternum
- no intrathoracic extension
• CT scan – not done
Preoperative on the operation table
Mass exposed
Defect after excision
Estimated size of the defect
Methylmethacrylate sandwiched in prolene
mesh
Methlmethacrylate secured to the defect
Estimated size of VRAM
Flap raised
Defect covered
Immediate post-op
One month post-op
Discussion
• Plexiform neurofibromas are benign nerve
tumour
• Usually congenital but may present during the
first year
• Generally painless slow growing neoplasms
• Most are asymptomatic
• Have potential for transformation
• Unfortunately, there is no effective medical
treatment for PNF
• Current management is limited to surgical
resection
• Decision about surgical management must be
made judiciously
• Multidisciplinary approach is advocated
• After chest wall resection, skeletal
reconstruction when appropriate and skin
coverage are essential elements
• Reconstruction is important to
 Maintain adequate ventilation
 Protect the heart and great vessels from trauma
 Maintain cosmetic integrity
- First report on the use of sandwich technique
- Since then it has been used worldwide
Reported excellent physiologic and aesthetic success
with methymetacrylate
Versatility of various flaps for chest wall
reconstruction
• Managed with plastic surgeons
• We used rigid coverage because vital
structures were exposed after excision
• Vertical rectus abdominis myocutaneous flap
was used to provide coverage
Conclusion
• Excision poses two challenges
 Defect
 Cosmesis
• Used of sandwich technique and soft tissue
closure with myocutaneous flap can overcome
these challenges
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