We report a rare case of a 37-year-old man who presented with a huge arteriovenous malformation in the head and neck region. After resection, the 30 × 25 cm defect was reconstructed with a preexpanded musculocutaneous latissimus dorsi flap. The facial nerve had to be sacrificed during the resection, and smile reanimation was restored in a second operation with the contralateral latissimus muscle flap. A 15-cm length of thoracodorsal nerve was dissected and was anastomosed to the contralateral zygomatic branch in a single stage. He recovered well without any significant complications. At 6 years follow-up, there was no further growth of the arteriovenous malformation, and he had a spontaneous smile.
From the *Department of Plastic, Reconstructive & Aesthetic Surgery, Singapore General, Hospital, Singapore; and
†Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan.
Received July 4, 2018, and accepted for publication, after revision January 11, 2019.
Conflict of interest and sources of funding: none declared.
Reprints: Manzhi Wong, MBBS, Department of Plastic, Reconstructive & Aesthetic Surgery, Academia, 20 College Rd, Singapore 169856. E-mail: firstname.lastname@example.org.
Online date: May 23, 2019