EFFICACY OF SUTURE LIGATION COMBINED WITH SUPER-WET TUMESCENT TECHNIQUES IN RESECTION OF PERIPHERAL ARTERIOVENOUS MALFORMATIONS OF HEAD AND NECK_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WANGZhongtang ¹ , HUANGXiaojin ² , LIJianning ³ , SUFu ⁴ , WANGMinlong ⁵

1. Department of Plastic Surgery, Zhongshan Hospital, Xiamen University, Xiamen Fujian, 361004, P. R. China;
2. Department of Vascular Surgery, Zhongshan Hospital, Xiamen University, Xiamen Fujian, 361004, P. R. China;
3. Department of Plastic Surgery, Peking University Third Hospital, Zhongshan Hospital, Xiamen University, Xiamen Fujian, 361004, P. R. China;
4. Department of Nuclear Medicine, Zhongshan Hospital, Xiamen University, Xiamen Fujian, 361004, P. R. China;
5. Department of Plastic Surgery, Xiamen Changgung Hospital, Zhongshan Hospital, Xiamen University, Xiamen Fujian, 361004, P. R. China;

Corresponding author：

WANGZhongtang, Email: wangkingking@hotmail.com

Keywords：

Arteriovenous malformation of the head and neck; Suture technique; Super-wet tumescent technique

DOI：

10.7507/1002-1892.20140300

Video：

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Objective To evaluate the feasibil ity and effectiveness of suture ligation combined with super-wet tumescent technique to replace embolization before surgical resection of peri pheral arteriovenous malformations (AVMs) of the head and neck. Methods Between July 2007 and November 2010, 9 patients with peri pheral AVMs of the head and neck were treated, including 4 males and 5 females with a median age of 21 years (range, 8 months to 55 years). The causes were congenital malformation in 6 cases, trauma in 2 cases, and unknown origin in 1 case. The lesions were located at the frontotemporal region in 2 patients, cheek in 2 patients, occi pitocervical region in 2 patients, temporoparietal region in 1 patient, upper lip in 1 patient, and lower lip in 1 patient. The size of the AVMs lesions ranged from 2.2 cm×1.2 cm to 13.0 cm×10.0 cm. Of 9 cases, 8 were classified as Schobinger gradeⅡand 1 as gradeⅢ. The AVMs involved 2 to 7 main nutrient arteries, with a diameter range of 1.7-3.1 mm. At one-stage operation, AVMs was removed and direct suture, skin graft or flaps were used for repair in 6 cases; the skin was expanded at one-stage operation, and then AVMs removal and repair were performed at twostage operation in 3 cases. Before resection of AVMs, No.7 silk suture was used to l igate the main nutrient vessels, and then annular interrupted suture of soft tissue was performed with the silk sutures around the lesions, at least two rings. Tumescent anesthetic solution was injected into lesions, and super wet end-point achieved. Results Partial incision dehiscence occurred in 1 patient; the flaps and grafting skin survived, and primary healing of incision was obtained in the other patients. The mean operation time was 136 minutes (range, 42-367 minutes). The mean intraoperative blood loss was 268 mL (range, 15-1 000 mL). Only 1 patient received 3 units of blood transfusion. All patients were followed up for 4.2 years on average (range, 2 years to 6 years and 6 months); there was no recurrence case. The self-assessment cosmetic results were excellent or good in 5 cases and fair in 4 cases. Conclusion Intensive suture ligation followed by super-wet tumescent techniques might partially substitute preoperative embolization to facil itate surgical resection of peri pheral AVMs of the head and neck, due to simple operation and less bleeding.

Citation： WANGZhongtang, HUANGXiaojin, LIJianning, SUFu, WANGMinlong. EFFICACY OF SUTURE LIGATION COMBINED WITH SUPER-WET TUMESCENT TECHNIQUES IN RESECTION OF PERIPHERAL ARTERIOVENOUS MALFORMATIONS OF HEAD AND NECK. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(11): 1385-1388. doi: 10.7507/1002-1892.20140300 Copy

1.	Kohout MP, Hansen M, Pribaz JJ, et al. Arteriovenous malformations of the head and neck:natural history and management. Plast Reconstr Surg, 1998, 102(3):643-654.
2.	Richter GT, Suen JY. Pediatric extracranial arteriovenous malformations. Curr Opin Otolaryngol Head Neck Surg, 2011, 19(6):455-461.
3.	Kumar R, Sharma G, Sharma BS. Management of scalp arterio-venous malformation:case series and review of literature. Br J Neurosurg, 2012, 26(3):371-377.
4.	Liu AS, Mulliken JB, Zurakowski D, et al. Extracranial arteriovenous malformations:natural progression and recurrence after treatment. Plast Reconstr Surg, 2010, 125(4):1185-1194.
5.	Hage ZA, Few JW, Surdell DL, et al. Modern endovascular and aesthetic surgery techniques to treat arteriovenous malformations of the scalp:case illustration. Surg Neurol, 2008, 70(2):198-203.
6.	Pompa V, Valentini V, Pompa G, et al. Treatment of high-flow arteriovenous malformation (AVMs) of the head and neck with embolization and surgical resection. Ann Ital Chir, 2011, 82(4):253-259.
7.	Taskin U, Yigit O, Bil ici S, et al. Giant arteriovenous malformation of the floor the mouth presenting with dysarthria and difficulty in swallowing. J Craniofac Surg, 2012, 23(2):e86-e88.
8.	Visser A, FitzJohn T, Tan ST. Surgical management of arteriovenous malformation. J Plast Reconstr Aesthet Surg, 2011, 64(3):283-291.
9.	Kumar R, Sharma G, Sharma BS. Management of scalp arteriovenous malformation:case series and review of literature. Br J Neurosurg, 2012, 26(3):371-377.
10.	Ermer MA, Gutwald R, Schumacher M, et al. Use of the radial forearm artery for secondary embolization of an extensive life-threatening arteriovenous malformation of the mid-face and anterior skull base-a case report. J Craniomaxillofac Surg, 2013, 41(3):258-264.
11.	Sun Y, Lv X, Li Y, et al. Complications caused by cerebral arteriovenous malformations embolization. Neuroradiol J, 2012, 25(5):541-547.
12.	Wang D, Su L, Fan X. Cardiovascular collapse and disseminated intravascular coagulation as complications of ethanol embolization of arteriovenous malformations in the upper lip:case report and literature review. J Oral Maxillofac Surg, 2014, 72(2):346-351.
13.	Schobinger R. Arteriosclerotic venopathy. A distinct disease entity. Bull Soc Int Chir, 1962, 21:385-391.
14.	Jackson IT, Keskin M, Yavuzer R, et al. Compartmentalization of massive vascular malformation. Plast Reconstr Surg, 2005, 115(1):10-21.
15.	Lee YS, Goh EK, Nam SB, et al. Multidisci plinary approach to lethal bleeding from an arteriovenous malformation in the external auditory canal. J Craniofac Surg, 2013, 24(6):2179-2182.
16.	赵继宗, 王硕, 周大彪, 等.头皮血管畸形的外科治疗.中华神经外科杂志, 1998, 14(4):210-212.
17.	Koshima I, Nanba Y, Tsutsui T, et al. Free perforator flap for the treatment of defects after resection of huge arteriovenous malformations in the head and neck regions. Ann Plast Surg, 2003, 51(2):194-199.
18.	肖海涛, 岑瑛, 刘勇, 等.皮肤软组织扩张技术在头皮扩张期动静脉畸形治疗中的应用.中国修复重建外科杂志, 2013, 27(2):249-250.
19.	Hormozi AK, Shafii MR. Supraclavicular flap:reconstructive strategy for massive facial arteriovenous malformations. J Craniofac Surg, 2011, 22(3):931-936.

1. Kohout MP, Hansen M, Pribaz JJ, et al. Arteriovenous malformations of the head and neck:natural history and management. Plast Reconstr Surg, 1998, 102(3):643-654.
2. Richter GT, Suen JY. Pediatric extracranial arteriovenous malformations. Curr Opin Otolaryngol Head Neck Surg, 2011, 19(6):455-461.
3. Kumar R, Sharma G, Sharma BS. Management of scalp arterio-venous malformation:case series and review of literature. Br J Neurosurg, 2012, 26(3):371-377.
4. Liu AS, Mulliken JB, Zurakowski D, et al. Extracranial arteriovenous malformations:natural progression and recurrence after treatment. Plast Reconstr Surg, 2010, 125(4):1185-1194.
5. Hage ZA, Few JW, Surdell DL, et al. Modern endovascular and aesthetic surgery techniques to treat arteriovenous malformations of the scalp:case illustration. Surg Neurol, 2008, 70(2):198-203.
6. Pompa V, Valentini V, Pompa G, et al. Treatment of high-flow arteriovenous malformation (AVMs) of the head and neck with embolization and surgical resection. Ann Ital Chir, 2011, 82(4):253-259.
7. Taskin U, Yigit O, Bil ici S, et al. Giant arteriovenous malformation of the floor the mouth presenting with dysarthria and difficulty in swallowing. J Craniofac Surg, 2012, 23(2):e86-e88.
8. Visser A, FitzJohn T, Tan ST. Surgical management of arteriovenous malformation. J Plast Reconstr Aesthet Surg, 2011, 64(3):283-291.
9. Kumar R, Sharma G, Sharma BS. Management of scalp arteriovenous malformation:case series and review of literature. Br J Neurosurg, 2012, 26(3):371-377.
10. Ermer MA, Gutwald R, Schumacher M, et al. Use of the radial forearm artery for secondary embolization of an extensive life-threatening arteriovenous malformation of the mid-face and anterior skull base-a case report. J Craniomaxillofac Surg, 2013, 41(3):258-264.
11. Sun Y, Lv X, Li Y, et al. Complications caused by cerebral arteriovenous malformations embolization. Neuroradiol J, 2012, 25(5):541-547.
12. Wang D, Su L, Fan X. Cardiovascular collapse and disseminated intravascular coagulation as complications of ethanol embolization of arteriovenous malformations in the upper lip:case report and literature review. J Oral Maxillofac Surg, 2014, 72(2):346-351.
13. Schobinger R. Arteriosclerotic venopathy. A distinct disease entity. Bull Soc Int Chir, 1962, 21:385-391.
14. Jackson IT, Keskin M, Yavuzer R, et al. Compartmentalization of massive vascular malformation. Plast Reconstr Surg, 2005, 115(1):10-21.
15. Lee YS, Goh EK, Nam SB, et al. Multidisci plinary approach to lethal bleeding from an arteriovenous malformation in the external auditory canal. J Craniofac Surg, 2013, 24(6):2179-2182.
16. 赵继宗, 王硕, 周大彪, 等.头皮血管畸形的外科治疗.中华神经外科杂志, 1998, 14(4):210-212.
17. Koshima I, Nanba Y, Tsutsui T, et al. Free perforator flap for the treatment of defects after resection of huge arteriovenous malformations in the head and neck regions. Ann Plast Surg, 2003, 51(2):194-199.
18. 肖海涛, 岑瑛, 刘勇, 等.皮肤软组织扩张技术在头皮扩张期动静脉畸形治疗中的应用.中国修复重建外科杂志, 2013, 27(2):249-250.
19. Hormozi AK, Shafii MR. Supraclavicular flap:reconstructive strategy for massive facial arteriovenous malformations. J Craniofac Surg, 2011, 22(3):931-936.

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Chinese Journal of Reparative and Reconstructive Surgery

EFFICACY OF SUTURE LIGATION COMBINED WITH SUPER-WET TUMESCENT TECHNIQUES IN RESECTION OF PERIPHERAL ARTERIOVENOUS MALFORMATIONS OF HEAD AND NECK

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