Surgical management of epistaxis in hereditary hemorrhagic telangiectasia

The most common manifestation of hereditary hemorrhagic telangiectasia (HH) is recurrent epistaxis. Numerous treatments have been used over the years, none proving entirely satisfactory. We have applied a new surgical treatment in seven selected cases of HHT with severe, life-threatening epistaxis. It consists of a near-total excision of the diseased nasal mucosa and its replacement by different skin flaps or a myocutaneous flap. This procedure has been performed since 1981. We stress the reliability and versatility of using the forehead myocutaneous island flap. Our original technique is described, follow-up of the patients is reported, and the criteria for selection of treatment are discussed.