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

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. 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. 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.