title: A prospective cohort study of fibula free flap donor-site morbidity in 157 consecutive patients.
abstract: BACKGROUND
  Although the fibula free flap is preferred for bony head and neck reconstruction, donor-site morbidity remains a concern. The authors' goal was to evaluate potential risk factors for complications and whether the type of wound closure and timing of postoperative ambulation had an effect on the development of short- and long-term morbidities.
  
  
  METHODS
  A prospective cohort study of donor-site morbidity was performed in 157 consecutive patients who underwent fibula free flap reconstruction for head and neck defects.
  
  
  RESULTS
  Perioperative donor-site complications occurred in 31.2 percent of patients, including skin graft loss (15 percent), cellulitis (10 percent), wound dehiscence (8 percent), and abscess (1 percent). Preoperative chemotherapy (p = 0.02) was associated with increased complications. No significant difference in complication rates was observed between primary and skin graft wound closure (p = 0.59). The timing of ambulation was not related to the development of complications (p = 0.41). Long-term morbidities occurred in 17 percent of patients and included leg weakness (8 percent), ankle instability (4 percent), great toe contracture (9 percent), and decreased ankle mobility (12 percent). The occurrence of perioperative complications, flap type, and closure technique were not significantly associated with long-term morbidities. Functionally, 96 percent of patients returned to their preoperative level of ambulatory activity. Decreases in ambulatory status could all be ascribed to causes other than donor-site morbidity.
  
  
  CONCLUSIONS
  Fibula free flap harvest is associated with a high rate of complications, but the majority of patients have no long-term functional limitations.
  
  
  METHODS
  Risk, IV.
authors.affiliation: Houston, Texas From the Departments of Plastic Surgery and Biostatistics, University of Texas M. D. Anderson Cancer Center.
authors.forename: Adeyiza O
authors.initials: AO
authors.lastname: Momoh
authors.forename: Peirong
authors.initials: P
authors.lastname: Yu
authors.forename: Roman J
authors.initials: RJ
authors.lastname: Skoracki
authors.forename: Suyu
authors.initials: S
authors.lastname: Liu
authors.forename: Lei
authors.initials: L
authors.lastname: Feng
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Hanasono
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003286:Contracture / Q000209:etiology; D005260:Female; D005360:Fibula / Q000601:surgery; D058752:Free Tissue Flaps; D005684:Gait; D006801:Humans; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D020360:Neoadjuvant Therapy; D010039:Otorhinolaryngologic Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012086:Reoperation; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery; D020858:Tissue and Organ Harvesting / Q000009:adverse effects*; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult