GH5 -- Two Cases of Vascular Pedicle Ossification Following Fibula Free Flap Reconstruction
Document Type
Event
Abstract
Introduction Vascular pedicle ossification (VPO) is a complication of fibular free flap (FFF) reconstruction that has a range of effects on patients, ranging from asymptomatic to requiring additional operations. This study describes a case of symptomatic VPO and evaluates for asymptomatic VPO within a series of FFF patients. Methods This study retrospectively investigates patients who had successful FFF reconstruction at a single tertiary medical center from April to December of 2021 and had available postoperative CT imaging. We evaluated postoperative imaging for the presence of VPO and documented the presence of any symptoms that are associated with VPO. Results Of the 4 FFF patients that were included in this study, 2 patients incurred VPO (50%). One patient had symptomatic VPO (25%) with the only symptom being a palpable mass, the other patient was asymptomatic. Neither patient had other significant complications or issues related to FFF failure. Further surgical intervention to resect the ossified pedicle was not pursued in either case. Results of the literature indicate that there is a high rate of asymptomatic VPO, but a low rate of symptomatic VPO and even lower rate of surgical reintervention. Conclusion This study supports previous literature reporting a significant incidence of symptomatic and especially asymptomatic VPO in FFF patients. VPO should be assessed for on postoperative imaging as symptomatic VPO can pose concern for tumor recurrence. Surgical resection of the ossified pedicle is only recommended if the patient is significantly symptomatic. Due to the relatively high incidence of asymptomatic VPO cases, it is currently unclear if adjustment of the FFF harvest technique to avoid this complication is worth the risk of damage to the FFF vascular pedicle.
Keywords
Graduate Health Sciences, Physiology
GH5 -- Two Cases of Vascular Pedicle Ossification Following Fibula Free Flap Reconstruction
URC Greatroom
Introduction Vascular pedicle ossification (VPO) is a complication of fibular free flap (FFF) reconstruction that has a range of effects on patients, ranging from asymptomatic to requiring additional operations. This study describes a case of symptomatic VPO and evaluates for asymptomatic VPO within a series of FFF patients. Methods This study retrospectively investigates patients who had successful FFF reconstruction at a single tertiary medical center from April to December of 2021 and had available postoperative CT imaging. We evaluated postoperative imaging for the presence of VPO and documented the presence of any symptoms that are associated with VPO. Results Of the 4 FFF patients that were included in this study, 2 patients incurred VPO (50%). One patient had symptomatic VPO (25%) with the only symptom being a palpable mass, the other patient was asymptomatic. Neither patient had other significant complications or issues related to FFF failure. Further surgical intervention to resect the ossified pedicle was not pursued in either case. Results of the literature indicate that there is a high rate of asymptomatic VPO, but a low rate of symptomatic VPO and even lower rate of surgical reintervention. Conclusion This study supports previous literature reporting a significant incidence of symptomatic and especially asymptomatic VPO in FFF patients. VPO should be assessed for on postoperative imaging as symptomatic VPO can pose concern for tumor recurrence. Surgical resection of the ossified pedicle is only recommended if the patient is significantly symptomatic. Due to the relatively high incidence of asymptomatic VPO cases, it is currently unclear if adjustment of the FFF harvest technique to avoid this complication is worth the risk of damage to the FFF vascular pedicle.