Consequences of bony free flap's pedicle calcification after jaw reconstruction

Most of the time, discovery of free flap pedicle calcification is fortuitous. We describe this phenomenon, try to elucidate its consequences, and discuss about prevention. We studied the effect of radiotherapy on the onset of calcification. We describe the first case of pedicle calcification with a scapula free flap.

We performed a retrospective study among the 162 bony free flaps harvested from 2003 to 2011. Follow-up included clinical examination, radiography, and head and neck computed tomography. We collected data including patients' age during free flap surgery, genre, primary disease, disease location, connected artery, ossification delay, clinical signs, flap vitality, and, eventually, calcification removal. We tested the effect of radiotherapy on the onset of calcification using a log-rank test.

We retrieved data of 15 patients with pedicle ossification after bony free flap (9.2%). Fibula free flap was present in 14 patients and scapula free flap was present in 1 patient. We noticed vascular pedicle ossification in 42% of our maxillary reconstructions and in 7% of our mandibular reconstructions. The maxillary-to-mandibular ratio is 5:10. Pedicle ossification was discovered between 92 and 366 days after surgery. We performed radiography for diagnosis. Clinical signs were reported in 6 patients. We removed ossified pedicle in 3 patients (20%) owing to pain, trismus, or hard cheek swelling. No free flap failure was noted among the 15 calcified pedicles. There was no statistically significant difference in the effect of radiotherapy on the onset of calcification (P = 0.126).

Ossification of the vascular pedicle is uncommon and probably underdiagnosed. Complications are rare, and surgical ossification removal should be reserved for patients with symptoms.