Multifactorial refractory heterotopic ossification.
Ectopic bone formation or "heterotopic ossification" can follow surgery, trauma, or neurologic injury, but the process is usually self-limited, localized to the site of injury, and responds to surgical treatment when necessary. Aggressive, systemic forms of heterotopic ossification exist that generate lesions that often resist surgical treatment and produce a high rate of recurrence. These entities typically manifest during infancy as genetic syndromes such as fibrodysplasia ossificans progressiva or progressive osseous heteroplasia. The authors describe a case of aggressive, systemic heterotopic ossification in an adult that followed a motor vehicle accident and multiple surgeries. The patient developed a large nonhealing wound around a focus of ectopic bone. Skin grafts failed as a result of the recurrence of ectopic bone, and the patient eventually required aggressive debridement and delayed rotational flap closure. A brief review of the clinical features and surgical treatment of heterotopic ossification is outlined.
Gear
Andrew J L
AJ
Department of Plastic Surgery, University of Minnesota, Minneapolis, MN, USA. agear@mindspring.com
Buckley
Claire
C
Kaplan
Fred
F
Vanbeek
Alan
A
D000063:Accidents, Traffic; D003646:Debridement / Q000379:methods; D006801:Humans; D035002:Lower Extremity / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology* / Q000601:surgery; D009999:Ossification, Heterotopic / Q000209:etiology / Q000473:pathology* / Q000601:surgery*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome