Vascular Pedicle Ossification After Jaw Reconstruction With Fibular Free Flap

Ossification of vascular pedicle in free fibular flap for jaw reconstruction was a rare complication. The aim of our study is to evaluate its consequence and propose our clinical experience with surgical management and outcomes of this complication. Our study includes patients who underwent jaw reconstruction with free fibular flap from Jan 2017 to Dec 2021. Patients were included only they had at least one computed tomography scan in follow-up period. Among 112 cases included in our study, 3 cases were observed of abnormal ossification along vascular pedicle who underwent maxilla (two patients) or mandibular (one patient) resection. Two patients who received maxilla resection present a progressive reduction in mouth opening after surgery, and CT scans showed calcified tissue around pedicle. Surgical revision was performed in one patient. Our experience show that periosteum preserves its osteogenic capability which allows the possibility of new bone formation along the vascular pedicle. Another important factor is mechanical stress. From our experience, it was necessary to remove periosteum from vascular pedicle only when mechanical stress of vascular pedicle were high, in order to avoid complication of vascular pedicle calcification. Surgical excision of calcification may be necessary only with clinical symptom. We believe this study could aid in understanding of pedicle ossification and contribute towards prevention and treatment of pedicle ossification.