Rare presentation of heterotopic ossification along a fibula free flap pedicle in a high‐volume microvascular reconstruction practice

Background Heterotopic ossification along free flap pedicles has been reported. Reports suggest that subperiosteal dissection of the pedicle from the bone during the harvest of the fibula free flap may predispose the pedicle to heterotopic ossification. Methods A 56‐year‐old man with history of a T2...

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Bibliographic Details
Published in:Head & neck 2018-03, Vol.40 (3), p.E21-E24
Main Authors: Mays, Ashley C., Gillenwater, Ann M., Garvey, Patrick B.
Format: Article
Language:English
Subjects:
Bone imaging
Bone mass
Bone surgery
Bone Transplantation - adverse effects
Cancer
Chemoradiotherapy
Fibula
Fibula - pathology
Fibula - transplantation
fibula free flap
Free Tissue Flaps - adverse effects
Head and neck
head and neck oncology
head and neck reconstruction
heterotopic ossification
Humans
Male
Mandible
Mandible - pathology
Mandible - surgery
microsurgery
Microvasculature
Middle Aged
Ossification (ectopic)
Ossification, Heterotopic - etiology
Ossification, Heterotopic - surgery
Osteoradionecrosis
Osteoradionecrosis - surgery
Periosteum
Postoperative Complications
Reconstructive Surgical Procedures - adverse effects
Squamous Cell Carcinoma of Head and Neck - surgery
Tomography, X-Ray Computed
Tonsil
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Summary:Background Heterotopic ossification along free flap pedicles has been reported. Reports suggest that subperiosteal dissection of the pedicle from the bone during the harvest of the fibula free flap may predispose the pedicle to heterotopic ossification. Methods A 56‐year‐old man with history of a T2N1M0 squamous cell cancer of the left tonsil who was treated with chemoradiation developed osteoradionecrosis of the mandible requiring fibula free flap reconstruction. The patient presented with a firm submandibular mass 1 year after reconstruction. Results Imaging revealed bone along the mandible projecting to the floor of the mouth. Surgery revealed heterotopic bone along the submandibular triangle and vascular pedicle. The bone was removed and the periosteum fulgurated to prevent further proliferation. Conclusion Our practice includes a high‐volume head and neck extirpative and reconstruction practice. To the best of our knowledge, this represents the first documented case of heterotopic ossification along a free flap pedicle despite routine subperiosteal elevation to free the peroneal artery from the proximal fibula.
ISSN:1043-3074
1097-0347
DOI:10.1002/hed.25039