USE OF A REGULATING FLAP IN THE TREATMENT OF A LARGE ARTERIOVENOUS MALFORMATION OF THE SCALP

A patient presented with a large arteriovenous malformation (AVM) of t he scalp. Afferent arterial embolisation followed by repeated surgical partial excision did not prevent recurrence and haemorrhage. The malf ormation was controlled with a latissimus dorsi muscle free flap which was positioned on the malformation. Five years later, haemorrhages di d not recur and the nidus has disappeared on the angiogram. The positi oning of a well-vascularised free tissue transfer provided long-term p alliation and the authors believe that this flap acted as a 'regulatin g flap'. As repeated surgery of these large AVMs always leads to rapid recurrences, the authors recommend treating large AVMs directly with a regulating flap when total excision is not possible.