Use of a regulating flap in the treatment of a large arteriovenous malformation of the scalp

A patient presented with a large arteriovenous malformation (AVM) of the scalp. Afferent arterialembolisation followed by repeated surgical partial excision did not prevent recurrence and haemorrhage. The malformation was controlled with a latissimus dorsi muscle free flap which was positioned on the malformation. Five years later, haemorrhages did not recur and the nidus has disappeared on the angiogram. The positioning of a well-vascularised free tissue transfer provided long-term palliation and the authors believe that this flap acted as a ‘regulating flap’. As repeated surgery of these large AVMs always leads to rapid recurrences, the authors recommend treating large AVMs directly with a regulating flap when total excision is not possible.