Defying Recurrence: Pioneering a Dual-Stage Surgical Solution for Recurrent Scalp Neurofibromas: A Rare Case Report

ABSTRACT: Scalp neurofibromas are the rare manifestations of neurofibromatosis type 1 (NF1), presenting unique challenges due to their location and potential for rapid growth. Management often involves surgical excision, but recurrence is common, especially if the excision is incomplete. This case report presents an innovative two-stage surgical approach for a recurrent scalp neurofibroma in a patient with NF1. A 48-year-old male with NF1 presented with a rapidly enlarging, painful lump in the left fronto-parietal area, which had been previously excised four times. A two-stage surgical approach was implemented. The first stage involved complete tumor excision from the subgaleal plane, followed by negative pressure wound therapy. The second stage, performed 10 days later, included free flap grafting using a rectus femoris and vastus lateralis flap, with split-thickness skin grafting. Histopathological examination confirmed spindle cell neurofibroma. Postoperative follow-up at 1 year showed no recurrence and satisfactory esthetic results. This case demonstrates the effectiveness of a carefully planned, two-stage surgical approach for managing recurrent scalp neurofibromas. The combination of aggressive excision and advanced reconstructive techniques can lead to successful outcomes in challenging cases. Multidisciplinary collaboration is crucial for the optimal management of complex NF1-related tumors.