Peripheral nerve tumors. Large neurofibroma of the foot

Abstract

A neurofibroma of the foot is an uncommon finding and may be associated with von Recklinghausen's disease. A case of a large, solitary neurofibroma is presented with no apparent systemic involvement on history and physical examination. The surgical approach and perioperative treatment for this lesion is presented, and a review of peripheral nerve tumors and neurofibromatosis. A tumor of this size poses many unforeseen problems: large dead space, wound dehiscence, and infection caused by hematoma formation. Preoperative magnetic resonance imaging to determine position, depth, and involvements of vital structures is invaluable. The lazy S incision allows for greater exposure with less skin tension from retraction, thus reducing the risk of wound dehiscence. Careful dissection prevents cutting or injuring of underlying atrophied tissue. Two years after surgery, the plantar muscle has returned to normal strength and size and only a slight amount of sensory deficit exists. His gait is normal, without limp, and with normal heel-to-toe ambulation. This patient's life-style has returned to normal with no alterations.