The rare phenomenon of vascular pedicle ossification of free fibular flap in mandibular reconstruction

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

“…12 Multiple theories have been proposed to account for this new bone formation, including active fracture repair at the osteotomy site, growth factors, mechanical tension, inflammation, and increased blood flow allowing osteoprogenitor recruitment. 12,14,16 These factors may all influence the development of bone formation, but the key underlying characteristic of the FFF is the presence of periosteum from the fibula to which the peroneal vascular pedicle is attached.…”

“…[9][10][11][12][13]16 Reported clinical manifestations of pedicle ossification include trismus, severe pain with mastication or head turning, submandibular swelling, or a hard palpable mass, though it is evident in the literature that such clinical findings are present in less than one-third of patients with imaging evidence of ossification and only 1 of our 16 patients was symptomatic. 10,[14][15][16] These clinical symptoms may mimic or raise clinical concern for recurrent tumor. The development of ossification in our patients was all within the 2-year postreconstruction period, when the concern for local tumor recurrence in HNSCC cases is greatest.…”

Consequences of Bony Free Flap’s Pedicle Calcification After Jaw Reconstruction

“…7 Considering this patient, the CT scan showed a dense calcification involving the whole volume of the fibular vessels. This aspect is similar to the one we retrieved in our retrospective study.…”

“…7 Obviously, considering FFF, the vascular pedicle is lining the periosteum after subperiosteal dissection; discarding the fibular proximal part, this dissection is meant for lengthening the pedicle. Nevertheless, SFF vascular pedicle calcification overthrows this theory because it does not require intimate contact between the pedicle and the periosteum.…”

Heterotopic ossification in the submental triangle remote from the vascular pedicle after reconstruction with a fibular free flap: a previously unreported complication

“…[1][2][3][4][5][6] We describe an extraordinary case of heterotopic ossification that arose remote from the pedicle and presented with a bony hard bridge in the submental region causing intermittent trismus and pain. * Corresponding author.…”