Aesthetic aspects of neurofibromatosis reconstruction with the vacuum-assisted closure system.

Everyone agrees that any reconstructive procedure should carry with it the maximum of aesthetic considerations in order that the reconstructive procedure presents the minimal deformities. Vacuum-assisted closure-(VAC) has allowed surgeons to achieve this goal by creating the most optimal conditions for proper wound healing and thus the best aesthetic results. We present a tragic case whereby a 28-year-old Hispanic male patient with neurofibromatosis was treated for a soccer ball-sized tumor located on his upper left leg. The treatment plan consisted of partial excision with local flap coverage of the wound; however, due to persistent bleeding and tumor growth within the flap, the flap did not survive and we were left with an open wound measuring 20 x 40 cm extending from the patient's upper knee to his iliac crest. Had we attempted an autograft procedure at this time, there would scarcely have been enough donor skin areas to cover the wound. VAC was implemented in an attempt to control the bleeding and to possibly decrease the size of the wound. With the application of this procedure, the previously uncontrollable bleeding (12 units) stopped immediately, and the wound size shrank to 1/2 of its original dimensions. As a result, the area for skin grafting was decreased and was completed with 100% take. The VAC system turned out to be advantageous in achieving the most optimal conditions for our patient's wound to close and heal properly, allowing for enhancement of the aesthetic considerations for the patient.