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Modified fibula free flap harvesting technique for prevention of heterotopic pedicle ossification
Author(s) -
Kim Beomjune B.,
Kaleem Arshad,
Alzahrani Shadi,
Yeoh Melvyn,
Zaid Waleed
Publication year - 2019
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.25711
Subject(s) - heterotopic ossification , medicine , trismus , ossification , surgery , fibula , complication , head and neck , free flap , tibia
Background Pedicle ossification is thought to arise from the residual perieosteum left along the pedicle during the fibula free flap (FFF) harvesting. Pedicle ossification in head and neck reconstruction can cause trismus, pain on mastication/turning the neck, or neck swelling. Methods Two patients reported in this article developed severe trismus within 6 months after mandibular reconstruction with FFF. CT scans revealed ossification along the vascular pedicle interfering with mouth opening. Both patients underwent surgical debridement of the heterotopic bone. Results Surgical debridement of the heterotopic bone led to the resolution of trismus in both patients with pedicle ossification. Conclusions Pedicle ossification is a complication of FFF that can be effectively managed by removal of heterotopic bone. However, it is best prevented at the time of initial surgery. In this article, a new modified FFF harvesting technique is introduced to prevent pedicle ossification and reduce the ischemia time.