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

Indian Journal of Plastic Surgery : Official Publication of the Association of Plastic Surgeons of India · 8 authors, 2 centres

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This retrospective cohort study included 16 patients with stage 4 Schobinger facial AVMs treated with a multimodality approach: pre-excisional embolization, radical excision, and reconstruction with microvascular free flaps. Over an average follow-up of 18.5 months, none of the 16 patients (0%) experienced locoregional recurrence.

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cohort

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surgery

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ORIGINAL PAPER

PMC10332899

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

Indian Journal of Plastic Surgery : Official Publication of the Association of Plastic Surgeons of India

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ABSTRACT

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

CITATION EXPORT

Thalaivirithan Margabandu Balakrishnan, P Ilayakumar, Bhattiprolu Vijay et al.. Regulating Microvascular Free Flaps Reconstruction in “Schobinger Stage 4” Arteriovenous Malformations of Face. Indian Journal of Plastic Surgery : Official Publication of the Association of Plastic Surgeons of India. (2023). https://doi.org/10.1055/s-0043-1767730

AUTHORS

8 · 2 CENTRES

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

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