Radical Resection of a Giant Facial Plexiform Neurofibroma in a Resource-Limited Setting

Giant facial plexiform neurofibromas (PNFs) in neurofibromatosis type 1 are surgically challenging, particularly in low- and middle-income countries where patients may present late and repeated staged procedures may be impractical. We report a 20-year-old woman from rural Zimbabwe with a massive recurrent left facial PNF after three prior debulking procedures. She underwent single-stage radical excision of involved skin, mucosa, parotid tissue, and facial nerve branches, followed by immediate anterolateral thigh free flap reconstruction and static facial suspension. Two units of packed red blood cells were transfused, the flap survived, and she was discharged on postoperative day 6. At 22 months, a small localized mucosal recurrence had been excised without further recurrence. This case, considered alongside a 34-patient operative experience, supports definitive macroscopic clearance with immediate reconstruction as a pragmatic strategy when repeated debulking is unlikely to provide durable benefit.