Donor Site Ischemic Events Following Fibula Flap Harvest in Head and Neck Recon-struction: A Case Report and Perioperative Management Strategies

Abstract

Morbidity associated with the donor site after harvesting free fibula flaps is generally considered low and most commonly related to complications associated with the healing of split skin graft closures. The occurrence of donor site ischemia following the harvesting of a fibula flap is uncommon, but if the event occurs, it may have catastrophic consequences. In this paper, the authors present a case study describing an ischemic lower limb following a free fibula harvest for head and neck reconstruction. A postoperative angiography revealed occlusion of the remaining anterior tibial and posterior tibial vessels, with only collateral circulation supplying the lower leg. In order to restore circulation to the leg, endovascular angioplasty of the anterior tibial artery was performed. Upon healing of the free osseocutaneous fibula flap at the recipient site (without complications), the patient was discharged and scheduled for outpatient follow-up. As a result of unfavorable wound healing at the donor site despite endovascular interventions, the patient's lower limb was later amputated below the knee. The authors present an overview of the preoperative, intraoperative, and postoperative strategies for diagnosing and managing complications associated with free fibula flap harvests.