Fibro-adipose vascular malformation (FAVA) in forearm: a successful surgical approach and literature review

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Fibro-adipose vascular anomaly (FAVA) is a new entity characterized by fibro-adipose infiltration of muscle, pain, and contracture. The main differential diagnosis includes venous malformation and intramuscular hemangioma. Early treatment and physical therapy are of paramount importance to prevent severe contractures, muscle fibrosis, and limb atrophy. We present a case report of a 24-year-old female patient with FAVA in the volar aspect of left arm, presented with limitation to pronation and supination and pain. The patient was operated in 2017 in our center, performing a total resection of the mass and 2-year follow-up. We describe the criteria that we performed to diagnose the left forearm FAVA in this patient, based on the history; the magnetic resonance imaging, which demonstrated muscle replaced by heterogeneous soft tissue, intramuscular phlebolit, and dilated vessels; and histological images that showed a vascular proliferation associated with adipocytes and dense fibrous tissue replacing and infiltrating the skeletal muscle. En bloc resection of the mass was performed successfully, and it gave excellent results with recovery of limitation and improvement of pain and swelling that were maintained at 2-year follow-up. Surgery is a reliable and curative option in FAVA and could be the only one for long-term control of this entity.

Level of evidence: Level V, therapeutic; diagnostic study.

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  1. 1.

    Shaikh R, Alomari A et al (2016) Cryoablation in fibro-adipose vascular anomaly (FAVA): a minimally invasive treatment option. Pediatr Radiol 46:1179–1186

  2. 2.

    Alomari A, Spencer S, Arnold R, Chaudry G, Kasser JR, Burrows PE, Govender P, Padua HM, Dillon B, Upton J, Taghinia AH, Fishman SJ, Mulliken JB, Fevurly RD, Greene AK, Landrigan-Ossar M, Paltiel HJ, Trenor CC 3rd, Kozakewich HP (2014) Fibro-adipose vascular anomaly: clinical-radiologic-pathologic features of a newly delineated disorder of the extremity. J Pediatr Orthop 34:109–117

  3. 3.

    Erickson J, McAuliffe W, Blennerhassett L, et al. (2017) Fibroadipose vascular anomaly treated with sirolimus: Successful outcome in two patients. Pediatr Dermatol, 34(6), e317–e320

  4. 4.

    Wassef M, Blei F, Adams D, Alomari A, Baselga E, Berenstein A, Burrows P, Frieden IJ, Garzon MC, Lopez-Gutierrez JC, Lord DJ, Mitchel S, Powell J, Prendiville J, Vikkula M, ISSVA Board and Scientific Committee (2015) Vascular anomalies classification: recommendations from the international society for the study of vascular anomalies. Pediatrics 136:e203–e214

  5. 5.

    Sheybani E, Eutsler E, Navarro O (2016) Fat-containing soft-tissue masses in children. Pediatr Radiol 46(13):1760–1773

  6. 6.

    Johnson C, Navarro O (2017) Clinical and sonographic features of pediatric soft-tissue vascular anomalies part 2: vascular malformations. Pediatr Radiol 47(9):1196–1208

  7. 7.

    Fernandez-Pineda I, Marcilla D, Downey-Carmona F et al (2014) Lower extremity fibro-adipose vascular anomaly (FAVA): a new case of a newly delineated disorder. Ann Vasc Dis 7(3):316–319

  8. 8.

    Ramaswamy R, Tiwari T, Darcy M et al (2019) Cryoablation of low-flow vascular malformations. Diagn Interv Radiol 25:225–230

  9. 9.

    Mende K, Vargesson N, Sivakumar B (2018) Vascular anomalies of the upper limb. J Hand Surg Eur Vol 44(3):233–241

  10. 10.

    Taghinia A, Upton J (2018) Vascular Anomalies. J Hand Surg [Am] 43(12):1113–1121

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Author information

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Susana López, Andreé Ibarra, Eulalia Baselga, Carmen Vega, Caterina Fumagalli, Sandra Valverde, and Jaume Masia. The first draft of the manuscript was written by Andreé Ibarra, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Correspondence to Andreé Ibarra.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from the individual participant included in the study. Informed written consent was obtained from the patient in this case report for inclusion of clinical data and photographs.

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López, S., Ibarra, A., Baselga, E. et al. Fibro-adipose vascular malformation (FAVA) in forearm: a successful surgical approach and literature review. Eur J Plast Surg (2020) doi:10.1007/s00238-019-01620-z

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  • FAVA
  • Vascular anomaly
  • Surgical treatment
  • Forearm