Arteriovenous fistula in a free pectoralis minor flap

Abstract

The acquired arteriovenous fistula, a rare occurrence, usually results from an identifiable traumatic insult. The precipitating event is often a penetrating injury, although other factors such as blunt injury, infection and changes in local haemodynamics can also initiate changes leading to such vascular anomalies. The subject of this report, a 42-year-old female, previously had an acoustic neuroma excised in September 1991, which left her with a dense right facial palsy. In an attempt to reconstruct the nerve, a facial reanimation procedure was performed. This was a two-stage procedure that involved a cross facial nerve graft, followed a year later by a free pectoralis minor flap. The aim was to introduce innervated muscle into the cheek to restore function and symmetry. The surgery was successfully completed in June 1997. This case report describes the appearance of an arteriovenous fistula following the use of a pectoralis minor free flap in facial reanimation. There are no published accounts of arteriovenous fistulae arising in free flaps in head and neck surgery.