PMC3266327_01
Preoperative angiogram demonstrating malformation with multiple coils.
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F1
Our patient is a 19-year-old man diagnosed with an arteriovenous malformation of the left lower leg before the age of 10 years from outside of the United States (Figs 1a and 1b).
Preoperative wound with exposed coils.
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F2
Skin grafting was attempted but failed, leaving him with a chronic abscess, significant limb edema, pain, foot drop, and severe restriction in his ambulation and activities of daily living (Fig 2).
Coils were removed at surgery and the posterior tibial nerve was protected.
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F3
The posterior tibial nerve was exposed, preserved, and protected with a collagen nerve conduit (Fig 3).
Angiogram after our first case demonstrating residual coils and vascular supply to the foot. A perforator joining the anterior and posterior circulations is marked 74 mm above the lateral malleolus.
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F4
A formal angiogram, obtained at this time to ascertain the vascular supply to the foot, showed trifurcation of the infrapopliteal vessels with embolized posterior tibial and peroneal arteries (Fig 4).
Postoperative appearance, with full wound healing and minimal residual edema.
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F5
At 4 months, the patient was ambulating fully with decreasing opiate requirements, and all wounds were well healed (Fig 5).