case_images: PMC3266327_01
case_images: Preoperative angiogram demonstrating malformation with multiple coils.
case_images: eplasty12e06_fig1.jpg
case_images: PMC3266327_01_eplasty12e06_fig1.jpg
case_images: F1
case_images: 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).
case_images: Preoperative wound with exposed coils.
case_images: eplasty12e06_fig2.jpg
case_images: PMC3266327_01_eplasty12e06_fig2.jpg
case_images: F2
case_images: 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).
case_images: Coils were removed at surgery and the posterior tibial nerve was protected.
case_images: eplasty12e06_fig3.jpg
case_images: PMC3266327_01_eplasty12e06_fig3.jpg
case_images: F3
case_images: The posterior tibial nerve was exposed, preserved, and protected with a collagen nerve conduit (Fig 3).
case_images: 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.
case_images: eplasty12e06_fig4.jpg
case_images: PMC3266327_01_eplasty12e06_fig4.jpg
case_images: F4
case_images: 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).
case_images: Postoperative appearance, with full wound healing and minimal residual edema.
case_images: eplasty12e06_fig5.jpg
case_images: PMC3266327_01_eplasty12e06_fig5.jpg
case_images: F5
case_images: At 4 months, the patient was ambulating fully with decreasing opiate requirements, and all wounds were well healed (Fig 5).