J Reconstr Microsurg 2011; 27(5): 295-298
DOI: 10.1055/s-0031-1278706
© Thieme Medical Publishers

Arteriovenous Fistula following Radial Forearm Free Flap

Jeremy Nikfarjam1 , Peter J. Taub2 , Aman Patel3 , Elliott Rose1
  • 1Department of Surgery, Albert Einstein College of Medicine, Bronx, New York
  • 2Division of Plastic and Reconstructive Surgery, Mount Sinai Medical Center, New York, New York
  • 3Department of Radiology, Mount Sinai Medical Center, New York, New York
Further Information

Publication History

Publication Date:
18 May 2011 (online)

ABSTRACT

The authors describe the development of a right facial arteriovenous fistula following debulking of a radial forearm free flap for reconstruction of the neck due to a burn contraction scar. The arteriovenous fistula was immediately excised following interventional embolization, without recurrence on postoperative follow-up. The authors report this as being the first arteriovenous fistula following a secondary debulking procedure, likely due to cross-clamping of the vascular pedicle. Thus, the authors recommend that the vascular pedicle be identified and that the artery and vein be selectively ligated during secondary debulking procedure following microvascular free flap reconstruction to avoid communication of the respective vessels potentially predisposing to development of an unintended arteriovenous fistula.

REFERENCES

  • 1 Karasch T, Rieser R, Neuerburg-Heusler D, Roth F J. Varicosis of the great saphenous vein as a main symptom of iatrogenic arteriovenous fistula.  Dtsch Med Wochenschr. 1991;  116 1871-1874
  • 2 Robbs J V, Carrim A A, Kadwa A M, Mars M. Traumatic arteriovenous fistula: experience with 202 patients.  Br J Surg. 1994;  81 1296-1299
  • 3 Maher S M, Rabee H M, Takrouri M S, Al-Salman M M. Traumatic arteriovenous fistula.  Ann Thorac Surg. 1997;  63 1792-1794
  • 4 Hurst L N, Rankin R N, Antonyshyn O M. Arteriovenous fistulas after replantation surgery.  Plast Reconstr Surg. 1986;  77 664-667
  • 5 Hunter W. Medical Observations and Inquiries. London: Johnston; 1757: 323-57
  • 6 Nandapalan V, O'Sullivan D G, Siodlak M, Charters P. Acute airway obstruction due to ruptured aneurysmal arterio-venous fistula: common carotid artery to internal jugular vein.  J Laryngol Otol. 1995;  109 562-564
  • 7 Ninkovic M, Sucur D, Starovic B et al.. Arteriovenous fistulae after free flap surgery in a replanted hand.  J Hand Surg Br. 1992;  17 657-659
  • 8 Badejo L, Rockwood P. Traumatic arteriovenous fistula of the scalp. Case report.  J Neurosurg. 1987;  66 773-774
  • 9 Cormack G C, Lambert B GH. The Arterial Anatomy of Skin Flaps. 1st ed. Edinburgh: Churchill Livingstone; 1986: 16-24
  • 10 Touho H, Furuoka N, Ohnishi H, Komatsu T, Karasawa J. Traumatic arteriovenous fistula treated by superselective embolisation with microcoils: case report.  Neuroradiology. 1995;  37 65-67
  • 11 Chang S H, Chiu T J, Tung K Y, Hsiao H T. Delayed arteriovenous fistulae formation in previous free ALT flap reconstruction of head and neck cancer.  J Plast Reconstr Aesthet Surg. 2009;  62 e635-e636
  • 12 Collin T W, Morris P, Sassoon E et al.. Arteriovenous fistula in a free pectoralis minor flap.  Eur J Plast Surg. 2003;  26 367-369

Jeremy NikfarjamM.D. 

Department of Surgery, Albert Einstein College of Medicine

1300 Morris Park Avenue, Bronx, NY 10461

Email: jnikfarj@einstein.yu.edu