YIJOM-3558; No of Pages 7 Please cite this article in press as: Hu L, et al. Reconstruction with soft tissue free flaps for large defects after the resection of giant facial neurofibroma, Int J Oral Maxillofac Surg (2016), http://dx.doi.org/10.1016/j.ijom.2016.11.013 Clinical Paper Clinical Pathology Reconstruction with soft tissue free flaps for large defects after the resection of giant facial neurofibroma L. Hu, Y. Xi, Y. Wang, L. Jiannan, J. Han, Y. Miao, S. Gokavarapu, C. Zhang, L. Xu: Reconstruction with soft tissue free flaps for large defects after the resection of giant facial neurofibroma. Int. J. Oral Maxillofac. Surg. 2016; xxx: xxx–xxx. # 2016 Published by Elsevier Ltd on behalf of International Association of Oral and Maxillofacial Surgeons. L. Hu, Y. Xi, Y. Wang, L. Jiannan, J. Han, Y. Miao, S. Gokavarapu, C. Zhang, L. Xu Department of Oral & Maxillofacial – Head & Neck Oncology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China Abstract. Giant facial neurofibroma leads to disfigurement and functional and neurological deficits. Surgical resection is the mainstay of treatment and poses a great challenge to the surgeon with regard to the restoration of the defects arising from tumour resection. The cases of three male and three female patients diagnosed with giant facial neurofibroma, who underwent radical resection and reconstruction with soft tissue free flaps between 2008 and 2015, were analyzed retrospectively. Clinical data including patient sex, age, preoperative embolization of the nutrient artery, volume of blood loss, type and size of flaps used for reconstruction, and complications were recorded. Three of the six patients underwent preoperative embolization of the nutrient artery. The average volume of blood loss was 2850 ml. Reconstruction was performed with anterolateral thigh flaps in four patients and latissimus dorsi myocutaneous flaps in two patients. All free flap reconstructions were successful. Partial necrosis of the scalp and wound dehiscence occurred in one patient each. All complications were managed successfully. In conclusion, the soft tissue free flap is a good choice for the coverage of defects after giant facial neurofibroma resection. Multi-disciplinary treatment should be strengthened to minimize the risks of complications, as well as improving quality of life. Key words: free flap; head and neck; neurofi- broma; multidisciplinary treatment. Accepted for publication 24 November 2016 Neurofibromatosis type 1 (NF1) is a com- mon autosomal domain disease and occurs in approximately 1 in 3000 live-births. 1 The clinical manifestations of NF1 include the presence of numerous cutaneous cafe ´ au lait spots, axillary freckling, and neurofibromas. 2 These tumours usually involve multiple nerve fascicles or the branches of major nerves and often lead to soft tissue overgrowth, resulting in dysfunction, pain, and disfigurement. 3 The management of progressive symp- tomatic neurofibromas, especially giant facial neurofibromas, is very challenging. Surgical resection is still a mainstay of treatment, as these tumours are radio- resistant and respond poorly to chemother- apy. 4,5 However, radical tumour resection usually results in large defects, which are very challenging to restore. NF1 tumours are highly vascularized and life-threatening Int. J. Oral Maxillofac. Surg. 2016; xxx: xxx–xxx http://dx.doi.org/10.1016/j.ijom.2016.11.013, available online at http://www.sciencedirect.com 0901-5027/000001+07 # 2016 Published by Elsevier Ltd on behalf of International Association of Oral and Maxillofacial Surgeons.