Abstract

Background: Facial arteriovenous malformation (AVM) is a high-flow vascular anomaly that may cause pain, inflammation, bleeding, or cosmetic deformity. Embolization is a widely used treatment method for facial AVMs; however, when conservative management fails, it becomes essential to transition to surgical intervention to manage complications and ensure the restoration of tissue integrity.

Case report: A 17-year-old female with a facial AVM of the left cheek and has undergone several embolization procedures for treatment. The lesion developed into a chronic abscess that did not respond to intravenous antibiotics. The surgical excision demonstrated significant fibrotic and necrotic tissue affecting the zygomatic musculature. The resulting defect was reconstructed using a free anterolateral thigh flap combined with vascularized fascia lata, anchored to the remaining facial musculature to restore dynamic support. The flap remained viable. At two-month follow-up, facial contour was stable and oral function was preserved.

Conclusion: Surgical excision followed by reconstruction using an ALT flap with vascularized fascia lata represents an effective option for managing facial AVMs complicated by fibrosis and secondary infection after repeated embolization, providing reliable restoration of both form and function.