While Enlarging congenital vascular malformations are challenging problem to surgeons, their etiology, classification, pathogenesis, and treatment are obscure so far. Normal embryology suggests that arteriovenous malformations consist of macrofistulae and microfistulae. These multiple fistulae represent a diffuse area of ischemia originated from the arteriovenous shunts and "complete control"or "cure"of arteriovenous malformation may rest with not only removal of the symptomatic area but also the replacement or addition of normally vascularized tissue to obliterate these ischemic environments.
In three patients with huge arteriovenous malformation on face, we have transferred radial forearm free flap after near total excision of the lesion, and followed up the patients 4 months to 2/,years grossly and histologically. The patients were cured completely and residual lesions next to the transferred free flap were obliterated. We think highly vascularized radial forearm flap might suppress the formation of new shunt due to re-establishment of ischemic condition in the lesion.
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