Ossification of the Vascular Pedicle in Microsurgical Fibular Free Flap Reconstruction of the Head and Neck

Glastonbury, Christine M.; Zante, Annemieke van; Knott, P. Daniel

doi:10.3174/ajnr.a3979

Cited by 21 publications

(13 citation statements)

References 13 publications

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“…This ossification can be seen in up to 50% of patients as soon as 1 month after the operation and may present clinically as a palpable mass. 36 Surveillance for tumor recurrence is the main focus of follow-up imaging. Primary site recurrences most often occur at the margins of the resection at the flap-native tissue interface and have nodular or masslike enhancement with signal characteristics similar to those of the original tumor (Fig 12).…”

Section: Radiologic Evaluation Following Ff Reconstructionmentioning

confidence: 99%

Imaging of Surgical Free Flaps in Head and Neck Reconstruction

McCarty

Corey²,

El‐Deiry

et al. 2018

AJNR Am J Neuroradiol

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Head and neck surgical reconstruction is complex, and postoperative imaging interpretation is challenging. Surgeons now use microvascular free tissue transfer, also known as free flaps, more frequently in head and neck reconstruction than ever before. Thus, an understanding of free flaps, their expected appearance on cross-sectional imaging, and their associated complications (including tumor recurrence) is crucial for the interpreting radiologist. Despite the complexity and increasing frequency of free flap reconstruction, there is no comprehensive head and neck resource intended for the radiologist. We hope that this image-rich review will fill that void and serve as a go to reference for radiologists interpreting imaging of surgical free flaps in head and neck reconstruction. ABBREVIATIONS: ALT ϭ anterolateral thigh; CECT ϭ contrast-enhanced CT; FF ϭ free flap; H&N ϭ head and neck; SCC ϭ squamous cell carcinoma Indicates open access to non-subscribers at www.ajnr.org http://dx.

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Section: Radiologic Evaluation Following Ff Reconstructionmentioning

confidence: 99%

Imaging of Surgical Free Flaps in Head and Neck Reconstruction

McCarty

Corey²,

El‐Deiry

et al. 2018

AJNR Am J Neuroradiol

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“…For these reasons, it is our opinion that FPF with scaffold should be considered as a routinely alternative to other second choices in decision-making algorithm. Usually, in head and neck reconstructive surgery, abnormal neo-ossification is considered a complication (e.g., ossification of the vascular pedicle of a free flap) [38]. However, as will be seen later, FPF may evolve in a guided vital bone segments when supported by an adequate scaffold, with better functional results rather than other options and with a possible ultimate dental rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

Free Periosteal Flaps with Scaffold: An Overlooked Armamentarium for Maxillary and Mandibular Reconstruction

Accorona

Gazzini

Grigolato

et al. 2021

Cancers

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Introduction: Head and neck bone reconstruction is a challenging surgical scenario. Although several strategies have been described in the literature, bone free flaps (BFFs) have become the preferred technique for large defects. Revascularized free periosteal flaps (FPFs) with support scaffold represents a possible alternative in compromised patient, BFF failure, or relapsing cancers as salvage treatment. However, only few clinical applications in head and neck are reported in literature. Purpose of the study was to systematically analyse the results of functional and oncologic maxillary and mandibular reconstruction with FPF with scaffold. Materials and Methods: A comprehensive review of the dedicated literature was performed according to the PRISMA guidelines searching on Scopus, PubMed/MEDLINE, Cochrane Library, Embase, Researchgate and Google Scholar databases using relevant keywords, phrases and medical subject headings (MeSH) terms. An excursus on the most valuable FPF’ harvesting sites was also carried out. Results: A total of 7 studies with 55 patients were included. Overall, the majority of the patients (n = 54, 98.1%) underwent an FPF reconstruction of the mandibular site. The most used technique was the radial forearm FPF with autologous frozen bone as scaffold (n = 40, 72.7%). The overall rate of complications was 43.7%. The success rate intended as scaffold integration resulted to be 74.5%. Conclusions: Maxillary and mandibular reconstruction with FPF and scaffold is a possible alternative in patient unfit for complex BFF reconstruction and it should be considered as a valid alternative in the sequential salvage surgery for locally advanced cancer. Moreover, it opens future scenarios in head and neck reconstructive surgery, as a promising tool that can be modelled to tailor complex 3D defects, with less morbidities to the donor site.

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“…While vascular pedicle calcification is a recognized phenomenon following osseous free flap reconstruction, the location of the heterotopic calcification seen in this case was not along the trajectory of the previously elevated supraclavicular pedicle. 4,5 Heterotopic calcification seen in other parts of the body are often only followed clinically but can be surgically removed in symptomatic cases. Heterotopic calcification requiring additional surgery should be considered a potential sequela of supraclavicular flap harvest when the clavicular periosteum is incorporated.…”

Section: Discussionmentioning

confidence: 99%