Heterotopic Ossification in Bony Free Flaps Used in Head-and-neck Reconstruction

Introduction: Heterotopic ossification (HO) is a rare occurrence in bony free flaps used in head-and-neck reconstructive surgery. HO is an incidental finding, described as a rare phenomenon in the literature. The periosteal theory is one of the most emphasized physiopathological descriptions for HO....

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Main Authors: Ahmet Rıfat Doğramacı, Gokce Yildiran, Osman Akdag, Hande Akdeniz, Mustafa Sutcu, Zekeriya Tosun
Format: Article
Language:English
Published: Wolters Kluwer Medknow Publications 2025-01-01
Series:Turkish Journal of Plastic Surgery
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Online Access:https://journals.lww.com/10.4103/tjps.tjps_14_24
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author Ahmet Rıfat Doğramacı
Gokce Yildiran
Osman Akdag
Hande Akdeniz
Mustafa Sutcu
Zekeriya Tosun
author_facet Ahmet Rıfat Doğramacı
Gokce Yildiran
Osman Akdag
Hande Akdeniz
Mustafa Sutcu
Zekeriya Tosun
author_sort Ahmet Rıfat Doğramacı
collection DOAJ
description Introduction: Heterotopic ossification (HO) is a rare occurrence in bony free flaps used in head-and-neck reconstructive surgery. HO is an incidental finding, described as a rare phenomenon in the literature. The periosteal theory is one of the most emphasized physiopathological descriptions for HO. This study aimed to address the causes, outcomes, and prevention of HO. Methods: This retrospective study included 30 patients undergoing reconstructive surgery for head-and-neck bone defects using bony free flaps. The patients underwent postoperative clinical examinations and computed tomography imaging. The age, sex, indications for reconstruction, ossification time, symptoms, and clinical findings were collected and reviewed. Results: The reviewed medical records showed that 5 patients developed HO after reconstruction with bony free flaps. Free fibula flap was used in 4 patients, whereas free medial femoral condylar flap was used in 1 patient. Conclusion: Clinical signs of HO were not observed in any patient. A modified approach with preservation of the periosteum is recommended in selected patients to avoid HO. Surgical ossification removal should be performed only in patients with symptoms.
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institution OA Journals
issn 2528-8644
language English
publishDate 2025-01-01
publisher Wolters Kluwer Medknow Publications
record_format Article
series Turkish Journal of Plastic Surgery
spelling doaj-art-947e1795e4e945eba11a7a2e051e3a5c2025-08-20T02:37:57ZengWolters Kluwer Medknow PublicationsTurkish Journal of Plastic Surgery2528-86442025-01-01331242710.4103/tjps.tjps_14_24Heterotopic Ossification in Bony Free Flaps Used in Head-and-neck ReconstructionAhmet Rıfat DoğramacıGokce YildiranOsman AkdagHande AkdenizMustafa SutcuZekeriya TosunIntroduction: Heterotopic ossification (HO) is a rare occurrence in bony free flaps used in head-and-neck reconstructive surgery. HO is an incidental finding, described as a rare phenomenon in the literature. The periosteal theory is one of the most emphasized physiopathological descriptions for HO. This study aimed to address the causes, outcomes, and prevention of HO. Methods: This retrospective study included 30 patients undergoing reconstructive surgery for head-and-neck bone defects using bony free flaps. The patients underwent postoperative clinical examinations and computed tomography imaging. The age, sex, indications for reconstruction, ossification time, symptoms, and clinical findings were collected and reviewed. Results: The reviewed medical records showed that 5 patients developed HO after reconstruction with bony free flaps. Free fibula flap was used in 4 patients, whereas free medial femoral condylar flap was used in 1 patient. Conclusion: Clinical signs of HO were not observed in any patient. A modified approach with preservation of the periosteum is recommended in selected patients to avoid HO. Surgical ossification removal should be performed only in patients with symptoms.https://journals.lww.com/10.4103/tjps.tjps_14_24free fibula flaphead-and-neck reconstructionheterotopic ossificationmedial femoral condylar flap
spellingShingle Ahmet Rıfat Doğramacı
Gokce Yildiran
Osman Akdag
Hande Akdeniz
Mustafa Sutcu
Zekeriya Tosun
Heterotopic Ossification in Bony Free Flaps Used in Head-and-neck Reconstruction
Turkish Journal of Plastic Surgery
free fibula flap
head-and-neck reconstruction
heterotopic ossification
medial femoral condylar flap
title Heterotopic Ossification in Bony Free Flaps Used in Head-and-neck Reconstruction
title_full Heterotopic Ossification in Bony Free Flaps Used in Head-and-neck Reconstruction
title_fullStr Heterotopic Ossification in Bony Free Flaps Used in Head-and-neck Reconstruction
title_full_unstemmed Heterotopic Ossification in Bony Free Flaps Used in Head-and-neck Reconstruction
title_short Heterotopic Ossification in Bony Free Flaps Used in Head-and-neck Reconstruction
title_sort heterotopic ossification in bony free flaps used in head and neck reconstruction
topic free fibula flap
head-and-neck reconstruction
heterotopic ossification
medial femoral condylar flap
url https://journals.lww.com/10.4103/tjps.tjps_14_24
work_keys_str_mv AT ahmetrıfatdogramacı heterotopicossificationinbonyfreeflapsusedinheadandneckreconstruction
AT gokceyildiran heterotopicossificationinbonyfreeflapsusedinheadandneckreconstruction
AT osmanakdag heterotopicossificationinbonyfreeflapsusedinheadandneckreconstruction
AT handeakdeniz heterotopicossificationinbonyfreeflapsusedinheadandneckreconstruction
AT mustafasutcu heterotopicossificationinbonyfreeflapsusedinheadandneckreconstruction
AT zekeriyatosun heterotopicossificationinbonyfreeflapsusedinheadandneckreconstruction