P21 / British Journal of Oral and Maxillofacial Surgery 52 (2014) e75–e127 e107

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Heterotopic Ossification after Oromandibular FibulaFree Flap Reconstruction

Ibraz Siddique ∗, Alan Robert Patterson

Rotherham NHS Foundation Trust

Introduction: Heterotopic ossification (HO) can be eitherhereditary or acquired and involves the formation of bone insoft tissue where bone normally does not exist. In the morecommon acquired form, HO can occur following trauma orsurgery. Although radiological evidence of HO after oro-mandibular fibula free flap reconstruction has been reported,a clinically detectable neck mass due to this phenomenon israre.

Method: Case report and review of related literature.Results: The development of a firm neck mass in a patient

after head and neck cancer treatment is frequently an indica-tion of tumour recurrence. A 62 year old male diagnosed witha left floor of the mouth/mandibular squamous cell carcinomaunderwent tumour resection, selective neck dissection andright fibula free flap reconstruction. He presented 5 monthspostoperatively with a firm left submandibular neck mass.To assess for tumour recurrence, ultrasound and subsequentCT scans were requested. These demonstrated the mass tobe osseous in nature and consistent with HO related to theproximal aspect of the fibula flap. We present clinical andradiological images demonstrating the features of HO in thiscase.

Clinical relevance: Surgeons should be aware of the pos-sibility of HO when encountering a firm neck mass in apatient after a fibula free flap reconstruction. An appropri-ate physical and radiographic assessment can distinguish HOfrom a recurrent tumour. HO after oncological oromandibu-lar free flap reconstruction can present diagnostic challenges.Early detection is important to plan appropriate manage-ment of possible complications which can have significantconsequences.

http://dx.doi.org/10.1016/j.bjoms.2014.07.193

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Comparison of outcome of Head and Neck reconstructionusing the fibular and iliac crest free flaps

Rabindra Singh ∗, J. Kelly, T. Teemul, D. Holt

York Teaching Hospital

The fibula and the deep circumflex iliac artery (DCIA)based iliac crest free flaps are commonly used by the Headand Neck surgeons to reconstruct the bony defects followingresection of benign and malignant tumours of the mandibleand the maxilla. The choice of the reconstructive optiondepends on the patient, defect and the donor site factors aswell as the expertise of the surgeon and the resources avail-able. Despite their popularity, it is surprising that there is little

published data in the literature comparing these two types offree flaps in Head and Neck reconstruction.

We discuss the evaluation of 36 patients who have hadfibular and DCIA flap reconstructions (23 fibulas, 13 DCIA)in our unit at the York Teaching Hospital, United Kingdom.We retrospectively assessed the medical notes with referenceto the pre-existing patient co-morbidity, type of the defect,flap success, salvage surgery as well as short and long-termpost-operative complications. The specific factors determin-ing the choice of reconstruction in decision-making processis also discussed.

http://dx.doi.org/10.1016/j.bjoms.2014.07.194

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A Brief History of Vascularised Free Flaps in the Oraland Maxillofacial Region

Ben Steel ∗, Cope

Hull University

Vascularised free flaps are the gold standard of reconstruc-tion of defects following cancer resection in this and otherspecialties, and have an interesting and surprisingly long his-tory. The first free flap was used in 1959, with most of thecurrently used free flaps described in the late 1970s/early1980s. This paper examines the history of 21 of the free flapsmost often used in Oral and Maxillofacial Surgery today. Thereconstructive techniques used in the pre-free-flap era, andthe developments in surgery that made free flaps possible,are described. This is in order to give the practicing Surgeonan idea of the origins of currently used techniques.

http://dx.doi.org/10.1016/j.bjoms.2014.07.195

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The role of microvascular couplers in head and neckreconstruction: A national survey of their use and ourexperience in Sunderland

William Thompson ∗, Mike Nugent

Sunderland Royal Hospital

Microvascular couplers have been available for severalyears now, with a proven track record of both efficiency andefficacy. We have recently introduced them to our practice inSunderland. We investigated the time taken for anastomosis,patency rates and costs. We were also interested to know howwidespread their usage is throughout the UK.

Method: The time taken to carry out sutured anastomosisand coupler anastomosis was recorded inter-operatively.

Costing implications were investigated by leasing with theclinical directors and theatre staff, as well as the supplier andstockists of the anastomosis equipment.

We asked each OMFS unit in the UK whether the couplerwas used in their practice.