FACIAL ARTERIOVENOUS MALFORMATION MANAGED WITH ABLATIVE SURGERY AND DUAL ROTATIONAL FLAP RECONSTRUCTION

A 34-year-old man had previously had partial resection of a left facia l hemangioma or arteriovenous malformation which included partial mand ibulectomy and external carotid arterial ligation for treatment of rec urrent bleeding. Because of recurrent intraoral bleeding with aspirati on and profound anemia and angiographic analysis showing large tortuou s abnormal vessels feeding the lesion from the cranial base, the patie nt had tracheostomy for airway control, radical left facial resection, completion hemimandibulectomy, and subtotal maxillectomy. He required 20 units of blood components intraoperatively. Oral reconstruction wa s done with a pedicled pectoralis major myocutaneous flap, and left fa cial reconstruction was done with a rotational transaxillary latissimu s dorsi myocutaneous flap supplemented with skin grafts as appropriate for coverage of the rotated muscles. Postoperatively, the patient has had no further oral bleeding. This case illustrates the multiple diff iculties involved in the surgical management of a high-flow arterioven ous malformation.