Surgical management and reconstruction of facial arteriovenous malformations

Kim, Jeong Tae; Kim, Seok Kwun

Abstract

Arteriovenous malfomation poses an unsolved, uncontrollable surgical challenge. Many therapeutic modalities have been introduced, but the great recurrence of the malformation after the radical resection should not be ignored. The altered hemodynamic conditions and newly formed ischemic areas after the surgical resection can accelerate the dormant artervenous shunt and stimulate the expansion of regional collaterals. So, the appropriate reconstruction method must be considered to prevent its recurrence. We have our own therapeutic principles; preoperative selective embolization, radical resection with saving the important structures, and well-vascularized tissue reconstruction such as island or free flap. 5 patients with facial arteriovenous malformations (2 on the temple, 2 on the auricle, 1 on the cheek), were treated with this modality and this concept can be expected to provide great remission of arteriovenous malformation. Free flap transfers were used in 3 cases. The feeding vessels of the arteriovenous malformation were used as recipient vessels of free flap, and so such hemodynamic redistribution of flow also limited the development of new arteriovenous shunts in ischemic field of resection.