Balakrishnan Thalaivirithan Margabandu, Ilayakumar P, Vijay Bhattiprolu, Christabel Prethee Martina, Prakash Divya, Elancheralathan K, Narayanan Sritharan, Janardhanam Jaganmohan
Department of Plastic and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, India.
Institute of Vascular Surgery, Madras Medical College, Chennai, Tamil Nadu, India.
Indian J Plast Surg. 2023 Mar 27;56(3):218-227. doi: 10.1055/s-0043-1767730. eCollection 2023 Jun.
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. 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. The average size of the flap harvested was 113.43 cm . Fourteen patients (87.5%) had good-to-excellent score ( = 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 ( = 0.035). 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.
动静脉畸形（AVM）是高流量、侵袭性病变，可产生全身影响并可能危及生命。这些病变难以治疗，因为它们在切除或栓塞后往往会剧烈复发。因此，需要一个具有强大血流的调节性游离皮瓣，以避免切除后缺血诱导的侧支循环形成、寄生现象以及从周围间充质募集新血管——这是一种促使AVM复发并使其持续存在的现象。2015年3月至2021年3月，对16例（12例男性和4例女性）面部累及Schobinger 4型AVM的患者采用了各种游离皮瓣进行治疗：3例采用游离腹直肌皮瓣，1例采用游离桡侧前臂皮瓣，12例采用游离股前外侧皮瓣，在广泛局部切除Schobinger 4型面部AVM后用于重建。对这些患者的记录进行了回顾性分析。平均随访期为18.5个月。采用机构评估评分对功能和美学结果进行分析。所采集皮瓣的平均大小为113.43平方厘米。在机构美学和功能评估系统中，14例患者（87.5%）获得了良好至优秀的评分（P = 0.035）。其余2例患者（12.5%）结果仅为一般。游离皮瓣组无复发（0%），而带蒂皮瓣和植皮组的复发率为64%（P = 0.035）。具有强大且均匀血供的游离皮瓣为缺损填充提供了良好途径，并在抑制AVM的任何局部复发方面具有出色的调节作用。
