Arteriovenous fistula following radial forearm free flap

The authors describe the development of a right facial arteriovenous fistula following debulking of a radial forearm free flap for reconstruction of the neck due to a burn contraction scar. The arteriovenous fistula was immediately excised following interventional embolization, without recurrence on postoperative follow-up. The authors report this as being the first arteriovenous fistula following a secondary debulking procedure, likely due to cross-clamping of the vascular pedicle. Thus, the authors recommend that the vascular pedicle be identified and that the artery and vein be selectively ligated during secondary debulking procedure following microvascular free flap reconstruction to avoid communication of the respective vessels potentially predisposing to development of an unintended arteriovenous fistula.