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J Craniofac Surg. 2011 Nov;22(6):e29-32. doi: 10.1097/SCS.0b013e31822ec950.

Periosteal ossification from the vascular pedicle of a free fibular flap.

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Department of Plastic, Reconstructive and Aesthetic Surgery, Çukurova University School of Medicine, Adana, Turkey.



Free fibular flap is commonly used in mandibular reconstruction. In some cases, to obtain a longer vascular pedicle, the peroneal artery and vein are stripped of the proximal fibula with its periosteum.


A 17-year-old patient evaluated with fibromyxoma of the mandible underwent excision of the tumor and reconstruction with a 6-cm free fibular flap. To obtain a longer pedicle, the peroneal artery and vein were stripped of the proximal fibula together with the periosteum. The recovery was uneventful. In his 6-month follow-up, there was a hard palpable stick-like mass (4 × 0.5 cm) 3 cm below the mandible. In the panoramic mandibular radiography, there was a radiopaque mass and ossification in the same location. The patient had no complaints, and no further treatment was done.


Periosteal ossification from the pedicle of the free fibular flap is a very rare phenomenon. However, because of the capacity of the periosteum to regenerate a new bone, it can be seen especially in younger patients. This can be prevented by a more careful dissection of the vascular pedicle from the bone and the periosteum. In cases where the primary disease is a tumor, it can be confused with recurrence. Depending on where the pedicle and the ossification are, it can give rise to symptoms or be totally asymptomatic.

[Indexed for MEDLINE]

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