Neck AV malformation resection

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Av malformation is a complex thing to treat with no easy solutions. They are of various types

Vascular tumors
1 infantile haemangioma
2 haemangioendothelioma
3Haemangiopericytoma



Slow flow malformations

1 capillary malformation
2 Venous malformations
3 Lymphatic malformation
4 Combined

Fast flow malformation

3 Arterial venous malformations
4 ArterialVeno fistula
5 combined

These vascular malformations come in various symptoms pain , bleeding , swelling, throbbing sensation , ulceration , compression.

pre op view




AV malformation post view











final defect

Final defect  skin flaps being tacked
Add caption
skin graft after one week

40 year old with a complex vascular malformation on posterior and lateral aspects of neck. He was operated 5 times .  MRI showed intramuscular and above fascia  extent of malformation. So it was decided to embolism below fascia malformation and excise above fascia malformation. Interventional  radiologist D embolised the inter muscular and below the muscle malformation. After 48 hrs patient was taken up for surgery and whole of malformation above muscle was excised and plication suture were taken to thrombose the vascular channel. original plan was to put a trapezius myocutaneous flap but later it was decided to put skin graft only.

Graft settled nicely, patient was given sclerotherapy on residual disease around margins.


skin graft with tie over dressing being placed





settled graft at two weeks


combination of radiological guided embolisation , sclerotherapy, surgical removal and reconstructive surgery will result in gratifying results in treatment of these complex problems. Good experience and sound surgical judgment is needed to safely treat these patients. Bleeding , wound healing issues and recurrence are common problems faced post op.




Dr Adhishwar Sharma
MBBS, MS Gen Surgery PGIMER Chd
Mch Plastic Surgery
Fellowship in hand and microvascular surgery
adhishwar7@gmail.com
8860650846

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