Hemodynamic considerations in the treatment of arteriovenous malformations of the face and scalp.

Our diagnostic and therapeutic approach to arteriovenous malformation is based on the available knowledge of the hemodynamics of these lesions. Four cases are presented. One demonstrates the deleterious effects of proximal vessel ligation. Two cases are treated with flow-controlled embolization, wide excision, and axial flap coverage of the defect with no recurrence on physical examination at more than 2 years. The final case illustrates a relatively small arteriovenous malformation that replaced one-half of the lower lip and chin. An extensive resection is done and the defect is reconstructed with an innervated and well-vascularized neck flap.