Flap reconstruction of extremity arteriovenous malformations (AVMs): Strategies and outcomes of a retrospective case series.

Abstract

Arteriovenous malformations (AVMs) are rare vascular anomalies associated with considerable morbidity and high recurrence rates. Their management remains challenging, with no universally accepted protocol. This study presents a standardized surgical approach developed at our institution, emphasizing early intervention, reconstruction with pedicled flaps or hybrid free flaps with venous bridging, and multidisciplinary care. A retrospective analysis of 16 patients (5 men and 11 women; aged 15-59 years) treated for extremity AVMs between 2010 and 2024 was conducted. Inclusion criteria encompassed AVMs in the limbs requiring surgical intervention with flap reconstruction. The key innovations in our treatment protocol were surgical excision using the "pineapple technique" and reconstruction with pedicled or hybrid free flaps with venous bridging to mitigate thrombotic risks. Indications for surgery included pain, numbness, bleeding, and chronic ulceration. Flap reconstruction had a 100% success rate, with complications occurring in 30% of cases. The recurrence rate was also 30% and recurrences were successfully managed through re-excision. Our findings support a multidisciplinary approach combining embolization and surgical excision with optimized reconstruction to minimize complications. Our protocol demonstrated the effectiveness of early, aggressive intervention and suggested its broader applicability, particularly in using pedicled flaps or hybrid free flaps with venous bridging over conventional free flaps to improve outcomes.