title: Prospective biomechanical analysis of donor-site morbidity after fibula free flap.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Oral & Maxillofacial Surgery (Head: Prof. Dr. Max Heiland), University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246 Hamburg, Germany. Electronic address: c.rendenbach@uke.de.
authors.forename: Carsten
authors.initials: C
authors.lastname: Rendenbach
authors.affiliation: Department of Oral & Maxillofacial Surgery (Head: Prof. Dr. Max Heiland), University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Kohlmeier
authors.affiliation: Department of Medical Biometry and Epidemiology (Head: Prof. Dr. Karl Wegscheider), University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Suling
authors.affiliation: Department of Oral & Maxillofacial Surgery (Head: Prof. Dr. Max Heiland), University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
authors.forename: Alexandre Thomas
authors.initials: AT
authors.lastname: Assaf
authors.affiliation: Institute of Osteology and Biomechanics (Head: Prof. Dr. Michael Amling), University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
authors.forename: Philip
authors.initials: P
authors.lastname: Catala-Lehnen
authors.affiliation: Institute of Osteology and Biomechanics (Head: Prof. Dr. Michael Amling), University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Amling
authors.affiliation: Department of Oral & Maxillofacial Surgery (Head: Prof. Dr. Max Heiland), University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
authors.forename: Max
authors.initials: M
authors.lastname: Heiland
authors.affiliation: Department of Oral & Maxillofacial Surgery (Head: Prof. Dr. Max Heiland), University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
authors.forename: Björn
authors.initials: B
authors.lastname: Riecke
mesh_terms: D016025:Bone Transplantation; D005360:Fibula / Q000601:surgery*; D058752:Free Tissue Flaps / Q000601:surgery*; D006801:Humans; D008334:Mandible / Q000601:surgery; D063175:Mandibular Reconstruction / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures; D013524:Surgical Flaps / Q000601:surgery
keywords: Biomechanical analysis; Donor-site morbidity; Free fibula flap; Jumping mechanography; Reconstructive surgery