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Tunneling and radiofrequency-assisted excision with scissor in neurofibromatosis
*Corresponding author: Avik Mondal, Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, Delhi, India. avik.mondal11@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Mondal A. Tunneling and radiofrequency-assisted excision with scissor in neurofibromatosis. CosmoDerma. 2024;4:79. doi: 10.25259/CSDM_81_2024
PROBLEM
One of the most prevalent autosomal dominant diseases, neurofibromatosis type 1 (NF1), also known as von Recklinghausen’s disease, manifests clinically as skeletal abnormalities, Lisch nodules, cutaneous neurofibromas, plexiform neurofibromas, axillary freckling, and optic nerve gliomas.[1] Usually, young patients of NF are concerned about their appearance, and removing several neurofibromas in one go is cumbersome, time consuming, and has a risk of intraoperative bleeding. Here, we have done a simple, bloodless, and time-saving procedure with an acceptable cosmetic outcome in a patient of NF1 by compiling a tunneling method[2] with a monopolar probe and radiofrequency-assisted excision with a scissor.
SOLUTION
After achieving adequate local infiltration anesthesia with 2 mL of 2% lignocaine, first, we used a pointed-tipped monopolar electrode in coagulating mode (power 20 watt) to create a tunnel circumferentially in the neurofibroma [Figure 1] by holding it with a toothed forceps for better stability. Then, we inserted a flat-tipped monopolar probe to make the hole bigger to accommodate the blade of a straight scissor. Then, we excised the tissue with a straight surgical scissor by inserting one blade into the tunnel. To make it bloodless, we continuously kept the monopolar probe in touch with the blade or the joint of the straight scissor in coagulation mode, while excising (power 10 watt) [Video 1]. The wound was allowed to heal with secondary intention [Figure 2]. There was minimal blood loss and the resection was relatively quick, making it an easy procedure to do allowing multiple excisions in one go.
- Multiple discrete well-defined neurofibromas. Larger one was excised.
- Wound healing phase (picture taken after 7 days of excision).
Ethical approval
The Institutional Review Board approval is not required.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Video 1 available on:
Financial support and sponsorship
Nil.
References
- Von Recklinghausen's disease associated with multiple neurolemomas. Arch Dermatol. 1971;104:172-6.
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- Monopolar electrosurgical tunneling combined with bipolar coagulation for bloodless resection of sessile benign skin lesions. J Am Acad Dermatol. 2021;85:e5-6.
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