Amputation and Immediate Total Ear Reconstruction for a Large Arteriovenous Malformation

Abstract

Summary: Due to the relative paucity of cases, there are no well-founded protocols for the management of large auricular arteriovenous malformations (AVMs) that are based on a significant number of cases. Recommendations in the literature generally separate resection of the malformation from a later reconstruction of the ear to allow for a period of disease-free status to minimize the risk of recurrence. This interval between resection and reconstruction can be cosmetically challenging for working adult patients. As auricular AVMs are often localized to the external ear, amputation is likely curative, and reconstruction should be considered at the time of resection. We present an adult male patient with a markedly enlarged left external ear secondary to a congenital AVM. The AVM was managed by auricular amputation without prior embolization. Immediate ear reconstruction was then performed using a porous polyethylene implant covered with an ipsilateral temporoparietal fascia flap. The flap was supplied by the superficial temporal artery. After 3 years, the patient has a cosmetically acceptable ear, with no signs of recurrence of the vascular malformation.