Modified fibula free flap harvesting technique for prevention of heterotopic pedicle ossification

Beomjune B. Kim, Arshad Kaleem, Shadi Alzahrani, Melvyn Yeoh, Waleed Zaid

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background: Pedicle ossification is thought to arise from the residual perieosteum left along the pedicle during the fibula free flap (FFF) harvesting. Pedicle ossification in head and neck reconstruction can cause trismus, pain on mastication/turning the neck, or neck swelling. Methods: Two patients reported in this article developed severe trismus within 6 months after mandibular reconstruction with FFF. CT scans revealed ossification along the vascular pedicle interfering with mouth opening. Both patients underwent surgical debridement of the heterotopic bone. Results: Surgical debridement of the heterotopic bone led to the resolution of trismus in both patients with pedicle ossification. Conclusions: Pedicle ossification is a complication of FFF that can be effectively managed by removal of heterotopic bone. However, it is best prevented at the time of initial surgery. In this article, a new modified FFF harvesting technique is introduced to prevent pedicle ossification and reduce the ischemia time.

Original languageEnglish (US)
Pages (from-to)E104-E112
JournalHead and Neck
Issue number7
StatePublished - Jul 2019


  • fibula
  • flap
  • ossification
  • pedicle
  • technique

ASJC Scopus subject areas

  • Otorhinolaryngology


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