Donor site morbidity following vascularized fibular grafting

Abstract

We examined donor site morbidity in thirty-nine patients with avascular necrosis of the femoral head treated by curettage and transplantation of a free ipsilateral fibular graft. Utilising our donor site morbidity questionnaire, scar, functional loss, wound healing, complications, and pain were analysed. Subjective complaints and objective findings were evaluated and compared. Subjective complaints were common and included a sense of instability in 42% and a sense of weakness in 37%. However, objective findings were limited. No clinical instability could be elicited and only great toe flexion (29%) and extension (43%) were found to be mildly weak. Only one patient required reoperation for a donor site problem (2%). Eighty-nine percent were pain free at time of follow-up, and 93% felt the scar was good. Range of motion of the knee and ankle of the donor site leg was not different from the nonoperated leg. Donor site morbidity for avascular necrosis of the femoral head is low.

Donor-Site Morbidity of Free Fibula and DCIA Flaps

“…Donor-site problems seemed more common after fibula harvest, but were relatively minor in nature. Tang et al 6 supported the findings of Rogers et al by stating that the DCIA free flap remained their first choice because the iliac bone did not require multiple osteotomies, the donor-site scar was more inconspicuous, and the cancellous quality of the iliac bone made rapid union feasible. However, several investigators have opted for the free fibula flap as their first choice for maxillofacial reconstruction because of the speed of harvest, dryness of the surgical field, abundance of soft tissue and bone, a thin and pliable skin paddle, and, importantly, the reported lower morbidity of the free fibula flap compared with the DCIA flap.…”

“…This was in contradiction to the finding of Tang et al, 6 in which 42% of patients complained of joint instability, but none was noted in the clinical evaluation. Ankle joint instability may be minimized by preserving 5 to 7 cm of distal fibula at the ankle.…”

Functional donor site morbidity longer than one year after fibula free flap: A prospective biomechanical analysis

“…Even after a mean follow‐up period of more than two and a half years, there is still a significant lack of sagittal motion with reduced dorsal extension and plantar flexion in the ankle joint and several patients complaining on load‐dependent pain and subjectively perceived limitations during everyday activities, consecutively resulting in a decreased AOFAS‐Score (Table a and b). Nevertheless, with an average scoring > 90 points postoperatively, overall functionality can still be regarded as good, which in turn is in accordance with the morbidity rates published by other research groups (Farhadi et al, ; Sieg, Taner, Hakim, & Jacobsen, ; Tang et al, ).…”

Functional Outcome of the Foot and Ankle After Free Fibular Graft

“…The frequency of donor site complications in our series was 23%, comparable to previous studies that showed a range between 15% and 55%. 1,2,6,12,14,15 Clawing of the first toe was the most common complication reported in our study (18%), and this deformity has been commonly noted in other studies. 6,8…”