Patient-Reported Outcomes after Fibula Free Flap Harvest: A Pilot Study

Abstract

Summary: Patient-reported outcomes regarding donor-site morbidity and quality of life for the fibula free flap in head and neck reconstruction patients have not been studied. The authors reviewed and identified patients who had undergone head and neck reconstruction using a fibula free flap (2011 to 2016). Patients were assessed via physical examination and two patient-reported outcomes questionnaires: the Foot and Ankle Outcome Score (score range, 0 to 100) and the Pain Disability Questionnaire (score range, 0 to 100). Quantitative data were analyzed with appropriate statistical tests. Semistructured interviews exploring donor-site challenges were performed and analyzed using thematic analysis. Seventeen patients agreed to participate. Their mean age was 62 years (range, 41 to 81 years). Mean follow-up was 38 months (range, 12 to 65 years). Mean perceived level of function compared to baseline was 67 percent. Mean scores for the Foot and Ankle Outcome Score subscales were 84.6 (pain), 80.5 (symptoms), 86.7 (activities of daily living), 67.7 (sport), and 65.6 (quality of life). The mean Pain Disability Questionnaire score was 26.3 (mild/moderate perceived disability). Higher perceived level of function was associated with higher Foot and Ankle Outcome Score values (pain, symptoms, and activities of daily living, p < 0.05). Donor limbs had decreased range of motion and manual muscle testing scores compared with their contralateral limbs (p < 0.05). Lack of ankle support and balance, resulting in limitations and aversions to daily and sporting activities, were the most common themes regarding donor-site challenges. In conclusion, patients who have undergone fibula free flap harvest struggle with ankle support and balance and face functional difficulties that have an impact on their quality of life. Multidisciplinary approaches for targeted rehabilitation after fibula free flap harvest should be explored to determine the impact on patients’ quality of life.

Comparison of patient‐reported upper extremity disability following free flaps in head and neck reconstruction: A systematic review and meta‐analysis

“…[35][36][37] Although this article focused primarily on DASH results for upper trunk free flaps, other studies have utilized lower-extremity-specific PROMs such as the Lower Limb Core Scale 38 or Foot and Ankle Outcome Score 39 to assess lower extremity flaps such as the fibular free flap (FFF). [40][41][42] Future studies using standardized PROMs across donor sites are necessary to enable surgeons to compare the morbidity of upper and lower extremity flaps and accurately tailor donor site selection to patient function, lifestyle, and hobbies.…”

Long-term patient-reported donor-site morbidity after free peroneal fasciocutaneous flap in head and neck reconstruction

“…We used a patient-reported questionnaire rather than objective instrumental analysis because patient-reported outcomes can more accurately reveal the level of discomfort and impact of donor-site morbidities on patients' daily lives. 15,16 The questionnaire that we use evaluates five distinct domains of donor-site complications. In the pain/sensory domain, 4 (4/39; 10.3%) of the patients reported mild pain (occasional and not intense) after at least 1 year of follow-up.…”

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

“…Complications related to the donor site following free fibula flap harvests are frequently attributed to delayed wound healing during the early phase of the postoperative course. However, chronic pain and/or gait disturbances have been reported as a result of donor site complications in the long-term [13][14][15][16]. The risk of serious complications following an ischemic event is rare [7,8,17,18].…”

“…Free fibula flaps have earned a stellar reputation; however, they do not always disclose significant donor site complications that may complicate the surgery. Various studies have revealed that chronic ankle pain and mobility issues can be unpredictable and potentially debilitating [13][14][15][16]. In contrast, compartment syndrome and vascular ischemia are not often mentioned in the literature, but their occurrence is possibly preventable.…”