Ossification of vascular pedicle in fibular free flaps: a report of four cases

Int J Oral Maxillofac Surg. 2008 Jul;37(7):669-71. doi: 10.1016/j.ijom.2008.01.023. Epub 2008 Mar 26.

Abstract

The fibular free flap is the most widely used flap for jaw reconstruction. Flap contouring requires removal of bone excess in the proximal segment by a subperiosteal dissection, preserving vascular connections between the pedicle and the bone and leaving well vascularized periosteum attached to the vascular pedicle. Among about 100 reconstructions with fibular flaps, 4 cases were observed of abnormal ossification along the vascular pedicle. Periosteum preserves its osteogenic capability after transposition, especially in a revascularized flap; this characteristic, together with the direct contact with the bone, allows the possibility of new bone formation along the pedicle. It would appear necessary to change the technique of reducing fibular excess, with removal of periosteum together with the bone, in order to avoid the complication described.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Bone Transplantation / adverse effects
  • Bone Transplantation / pathology*
  • Carcinoma, Squamous Cell / surgery
  • Fibula
  • Humans
  • Male
  • Mandibular Injuries / surgery
  • Mandibular Neoplasms / surgery
  • Maxilla / abnormalities
  • Maxilla / surgery
  • Maxillary Neoplasms / surgery
  • Middle Aged
  • Ossification, Heterotopic / etiology*
  • Osteosarcoma / surgery
  • Periosteum / pathology
  • Periosteum / transplantation
  • Plastic Surgery Procedures / adverse effects*
  • Surgical Flaps / adverse effects
  • Surgical Flaps / blood supply*
  • Wounds, Gunshot / surgery