Facial Plexiform Neurofibroma excision with sequential muti-layer hemostatic sutures, the novel technique to reduce blood loss

Plexiform neurofibromatosis is an autosomal dominant and is frequently seen at birth. Surgical excision is asociate to facial nerve damage and profussal bleeding. Sequential multi-layered hemostatic sutures is a technique frequently used in our practice for Arterio-veous malfromations (AVM). 15 patiets with facial plexiform neurofibroma were treated from 2004 to 2020 with surgical excision, in all patients the hemifacial area was affected. Although preoperative embolization is well known as a safe technique to reduce intraoperative bleeding, low rates of serious complications were reported as stroke, ischemic attack and necrosis. The multi-layered hemostatic sutures permit to remove piecewise the tumor avoiding dramatically bleeding in all our procedures, and is based on vessel collapse after mechanical ligation. The sequential multi-layer suture and the retrograde disection of the facial nerve in our practice has decresed the average of iatrogenic damage of nerve, and massive bleeding during the excision of the plexiform neurofibroma.