Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, United States of America.
Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, United States of America.
Am J Otolaryngol. 2021 Jul-Aug;42(4):102990. doi: 10.1016/j.amjoto.2021.102990. Epub 2021 Feb 17.
Heterotopic ossification of a vascular pedicle is an uncommon, but established, phenomenon occasionally seen incidentally on post-operative imaging after fibular free flap reconstruction. Symptomatic cases of pedicle ossification, however, are much rarer, with very few cases requiring operative intervention. We present the largest case of pedicle ossification recorded to date, review the literature on symptomatic pedicle ossification, and describe our experience with the surgical management and outcomes of this complication in symptomatic patients.
A 60-year-old man with a 7 cm neck mass and neck pain presents six months after fibular free flap reconstruction of an osteonecrotic mandible. CT demonstrates heterotopic ossification of the free flap vascular pedicle. The patient underwent surgical resection of the ossification with preservation of the pedicle and had an uncomplicated post-operative course with resolution of symptoms.
While pedicle ossification following fibula free flap surgery appears to be a somewhat common occurrence in the literature, clinically significant and symptomatic cases are rare. Symptomatic pedicle ossification may require secondary surgical intervention if large, painful, or disfiguring. Although there are surgical techniques described which may decrease the incidence of postoperative ossification, the rarity of symptomatic cases may not justify the additional surgical risks created by subperiosteal dissection.
Here, we present what appears to be the largest case of pedicle ossification in the literature. We believe this case may aid in the understanding of pedicle ossification and contribute towards a standard treatment protocol in the prevention and treatment of clinically relevant pedicle ossification.
血管蒂异位骨化是一种不常见但已确立的现象，偶尔在腓骨游离皮瓣重建术后的影像学检查中发现。然而，症状性蒂骨化病例更为罕见，需要手术干预的病例非常少。我们报告了迄今为止记录到的最大一例蒂骨化病例，回顾了症状性蒂骨化的文献，并描述了我们在症状性患者中对这种并发症的手术管理和结果的经验。
一名 60 岁男性，因患有骨坏死下颌骨而接受了腓骨游离皮瓣重建，术后 6 个月出现 7 厘米的颈部肿块和颈部疼痛。CT 显示游离皮瓣血管蒂异位骨化。患者接受了骨化切除术，保留了蒂，术后无并发症，症状缓解。
尽管文献中报道腓骨游离皮瓣手术后出现蒂骨化似乎较为常见，但临床上出现明显症状的病例较为罕见。如果蒂骨化较大、疼痛或影响外貌，可能需要进行二次手术干预。虽然有描述的手术技术可以降低术后骨化的发生率，但症状性病例的罕见性可能不足以证明通过骨膜下剥离术带来的额外手术风险是合理的。
在这里，我们报告了文献中似乎最大的一例蒂骨化病例。我们认为该病例有助于理解蒂骨化，并有助于制定预防和治疗临床相关蒂骨化的标准治疗方案。
