Prospective biomechanical analysis of donor-site morbidity after fibula free flap

PURPOSE: The fibula free flap (FFF) is a standard method for osseous reconstruction. The purpose of this study was to investigate functional deficits after harvesting a free fibula flap.

MATERIAL AND METHODS: We designed and implemented a prospective clinical cohort study. The study sample consisted of patients undergoing mandible resection and reconstruction with a fibula free flap. The primary endpoint was the time-dependent difference in maximum peak power per body mass (MPP). In addition, balance ability, American Orthopedic Foot and Ankle Society (AOFAS) score, sensory limitations, general surgical complications, and the range of motion were recorded.

RESULTS: A total of 27 patients were examined pre- and postoperatively (8 months on average). MPP and balance ability were significantly reduced (p < 0.001) postoperatively. Furthermore, a deficit in dorsal extension and a considerable reduction of the AOFAS score were recorded. For the primary outcome, there were no significant predictors on multivariate analysis.

CONCLUSIONS: Our results indicate a postoperative reduction of lower limb performance with a relevant impact on everyday activities, equivalent to the average loss of 7 life years of a healthy, fit individual. However, these data do not challenge the value of this commonly used microvascular graft. Future efforts should focus on the development of strategies to minimize the associated donor-site morbidity.