[Efficacy of suture ligation combined with super-wet tumescent techniques in resection of peripheral arteriovenous malformations of head and neck].

OBJECTIVE

To evaluate the feasibility and effectiveness of suture ligation combined with super-wet tumescent technique to replace embolization before surgical resection of peripheral arteriovenous malformations (AVMs) of the head and neck.

METHODS

Between July 2007 and November 2010, 9 patients with peripheral 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, occipitocervical 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 x 1.2 cm to 13.0 cm x 10.0 cm. Of 9 cases, 8 were classified as Schobinger grade II and I as grade III. 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 two- stage operation in 3 cases. Before resection of AVMs, No.7 silk suture was used to ligate 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 facilitate surgical resection of peripheral AVMs of the head and neck, due to simple operation and less bleeding.