Atypical case of arteriovenous malformation invading into a pedicled medial arm flap

A 54-year-old woman who had previously undergone total excision of an arteriovenous malformation (AVM) of lower lip and chin along with pedicled medial arm flap reconstruction, presented with recurrence of swelling in the same region. The patient reported progressive difficulty in feeding, talking and constant aching pain besides aesthetic concerns. On evaluation, recurrence of AVM with invasion into the flap substance was identified. We performed debulking surgery, which resulted in a considerable reduction in pain and improved lower lip functioning and aesthetic appeal of the face. This case is unique due to the rare presentation of an AVM invading the normal flap tissue. Such a finding has never been reported before for a pedicled flap, along with details of the histopathology and imaging description. There are lacunae in the understanding of the progression of vascular malformations and this additional information will add to the existing literature on AVM.