{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:23:18Z","timestamp":1753888998708,"version":"3.40.5"},"reference-count":4,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,6,5]],"date-time":"2023-06-05T00:00:00Z","timestamp":1685923200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp; Neck"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Iatrogenic injury of the fibula free flap pedicle is rare. Postoperative flap survival and reconstructive outcomes following intraoperative pedicle severance are unknown. This study assesses free flap outcomes following accidental severance of the peroneal vessels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Multi\u2010institutional retrospective chart review from 2000 to 2020.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 2975 harvested fibula free flaps, 26 had a history of pedicle severance during surgical reconstruction. Reasons for intraoperative pedicle severance included transection during muscular dissection 10\/26 (39%), accidental severance with the bone saw 12\/26 (46%), and other 4\/26 (15.6%). The surgeon responsible for pedicle severance included residents 5\/26 (19%), fellows 10\/26 (39%), attendings 10\/26 (39%), and unknown 1\/26 (3.9%). The pedicle artery and vein were severed 10\/26 (39%), artery 8\/26 (31%), and vein 8\/26 (31%). Truncated pedicle vessels were used 3\/26 (11.7%), intraoperative anastomoses were performed 23\/26 (89%). Postoperative revision in the OR within 7\u2009days of surgery was required 6\/26 (23%); 4 flaps were salvaged and 2 flaps failed, both arterial thrombosis. Flap failure was attributed to vascular thrombosis. Long\u2010term flap survival and successful reconstructions were reported 24\/26 (92%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Accidental severance of fibula free flap pedicle vessels can be corrected with intraoperative repair, without affecting long\u2010term flap survival or reconstructive outcomes. Protecting the flap vessels while using the bone saw and during intramuscular dissection prevents accidental severance.<\/jats:p><\/jats:sec>","DOI":"10.1002\/hed.27423","type":"journal-article","created":{"date-parts":[[2023,6,7]],"date-time":"2023-06-07T11:21:35Z","timestamp":1686136895000},"page":"1975-1978","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical outcomes following intraoperative pedicle disruption in fibula free flaps"],"prefix":"10.1002","volume":"45","author":[{"given":"Jonathan","family":"Jelmini","sequence":"first","affiliation":[{"name":"Oral and Maxillofacial Surgery Oregon Health &amp; Science University  Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5181-5897","authenticated-orcid":false,"given":"Allison A.","family":"Slijepcevic","sequence":"additional","affiliation":[{"name":"Wake Forest Baptist Medical Center  Winston\u2010Salem North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Urjeet","family":"Patel","sequence":"additional","affiliation":[{"name":"Otolaryngology\u2014Head and Neck Surgery Northwestern Medical Faculty Foundation  Birmingham Alabama USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Larissa","family":"Sweeny","sequence":"additional","affiliation":[{"name":"University of Miami Miller School of Medicine  Miami Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrik","family":"Pipkorn","sequence":"additional","affiliation":[{"name":"Washington University in Saint Louis School of Medicine  Saint Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yadro","family":"Ducic","sequence":"additional","affiliation":[{"name":"Otolaryngology\u2014Head and Neck Surgery Head &amp; Neck Cancer Center of Texas  Birmingham Alabama USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justine","family":"Moe","sequence":"additional","affiliation":[{"name":"Oral and Maxillofacial Surgery University of Michigan  Ann Arbor Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Pittman","sequence":"additional","affiliation":[{"name":"Otolaryngology Loyola Medicine  Maywood Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karthik","family":"Rajasekaran","sequence":"additional","affiliation":[{"name":"University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Diaz","sequence":"additional","affiliation":[{"name":"ENT Center Utah H&amp;N Surgical Oncology and Reconstruction  Salt Lake City Utah USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carissa","family":"Thomas","sequence":"additional","affiliation":[{"name":"The University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Byrne","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Health System Head and Neck Institute  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Rich","sequence":"additional","affiliation":[{"name":"Washington University in Saint Louis School of Medicine  Saint Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5603-1434","authenticated-orcid":false,"given":"Akina","family":"Tamaki","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine, ENT  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liana","family":"Puscas","sequence":"additional","affiliation":[{"name":"Duke University  Durham North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Petrisor","sequence":"additional","affiliation":[{"name":"Oral and Maxillofacial Surgery Oregon Health &amp; Science University  Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0250-8636","authenticated-orcid":false,"given":"Mark K.","family":"Wax","sequence":"additional","affiliation":[{"name":"Otolaryngology OHSU  Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,6,5]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjoms.2017.08.363"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599820912727"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.26427"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOO.0000000000000739"}],"container-title":["Head &amp; Neck"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hed.27423","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T10:14:31Z","timestamp":1692267271000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hed.27423"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,5]]},"references-count":4,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2023,8]]}},"alternative-id":["10.1002\/hed.27423"],"URL":"https:\/\/doi.org\/10.1002\/hed.27423","archive":["Portico"],"relation":{},"ISSN":["1043-3074","1097-0347"],"issn-type":[{"type":"print","value":"1043-3074"},{"type":"electronic","value":"1097-0347"}],"subject":[],"published":{"date-parts":[[2023,6,5]]},"assertion":[{"value":"2022-09-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-05-21","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-05","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}