title: Periosteal ossification from the vascular pedicle of a free fibular flap.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Plastic, Reconstructive and Aesthetic Surgery, Çukurova University School of Medicine, Adana, Turkey. toacarturk@yahoo.com
authors: Tahsin Oğuz
authors: TO
authors: Acartürk
authors: Emrah Efe
authors: EE
authors: Aslaner
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical; D016025:Bone Transplantation / Q000473:pathology; D005350:Fibroma / Q000175:diagnosis / Q000601:surgery*; D005360:Fibula / Q000637:transplantation*; D058752:Free Tissue Flaps / Q000098:blood supply / Q000473:pathology*; D006801:Humans; D008297:Male; D008339:Mandibular Neoplasms / Q000175:diagnosis / Q000601:surgery*; D009999:Ossification, Heterotopic / Q000473:pathology*; D010521:Periosteum / Q000473:pathology*; D011183:Postoperative Complications / Q000473:pathology*; D011862:Radiography, Panoramic; D019651:Plastic Surgery Procedures / Q000379:methods*; D014057:Tomography, X-Ray Computed