Regulating Microvascular Free Flaps Reconstruction in "Schobinger Stage 4" Arteriovenous Malformations of Face

Thalaivirithan Margabandu Balakrishnan; P Ilayakumar; Bhattiprolu Vijay; Prethee Martina Christabel; Divya Prakash; K Elancheralathan; Sritharan Narayanan; Jaganmohan Janardhanam

doi:10.1055/s-0043-1767730

Regulating Microvascular Free Flaps Reconstruction in "Schobinger Stage 4" Arteriovenous Malformations of Face

Indian J Plast Surg. 2023 Mar 27;56(3):218-227. doi: 10.1055/s-0043-1767730. eCollection 2023 Jun.

Authors

Thalaivirithan Margabandu Balakrishnan¹, P Ilayakumar², Bhattiprolu Vijay¹, Prethee Martina Christabel¹, Divya Prakash¹, K Elancheralathan², Sritharan Narayanan², Jaganmohan Janardhanam¹

Affiliations

¹ Department of Plastic and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, India.
² Institute of Vascular Surgery, Madras Medical College, Chennai, Tamil Nadu, India.

Abstract

Objectives Arteriovenous malformations (AVMs) are high-flow, aggressive lesions that cause systemic effects and may pose a risk to life. These lesions are difficult to treat as they have a tendency to recur aggressively after excision or embolization. So, it requires a regulating free flap with robust vascular flow averting the postexcisional ischemia-induced collateralization, parasitization, and recruitment of neovessels from the surrounding mesenchyme-a phenomenon precipitating and perpetuating the recurrence of AVM. Materials and Methods Sixteen patients (12 males and 4 females) with AVMs Schobinger type 4 involving face were treated from March 2015 to March 2021 with various free flaps: three free rectus abdominis flaps, one free radial forearm flap, and twelve free anterolateral thigh flaps were used for reconstruction following the wide local excision of Schobinger type 4 facial AVM. The records of these patients were analyzed retrospectively. The average follow-up period was 18.5 months. The functional and aesthetic outcomes were analyzed with institutional assessment scores. Results The average size of the flap harvested was 113.43 cm ² . Fourteen patients (87.5%) had good-to-excellent score ( p = 0.035) with institutional aesthetic and functional assessment system. The remaining two patients (12.5%) had only fair results. There was no recurrence (0%) in the free flap group versus 64% recurrence in the pedicled flap and skin grafting groups ( p = 0.035). Conclusion Free flaps with their robust and homogenized blood supply provide a good avenue for void filling and an excellent regulating effect in inhibiting any locoregional recurrences of AVMs.

Keywords: facial arteriovenous malformations; microvascular reconstruction; regulating free flaps.

Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).