The Fibula Osteocutaneous Flap in Head and Neck Reconstruction: A Critical Evaluation of Donor Site Morbidity | Dermatology | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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1.
Urken  ML Composite free flaps in oromandibular reconstruction.  Arch Otolaryngol Head Neck Surg. 1991;117724- 732Google ScholarCrossref
2.
Urken  MLWeinberg  HBuchbinder  D  et al.  Microvascular free flaps in head and neck reconstruction.  Arch Otolaryngol Head Neck Surg. 1994;120633- 640Google ScholarCrossref
3.
O'Leary  MJMartin  PJHayden  RE The neurocutaneous free fibula flap in mandibular reconstruction.  Otolaryngol Clin North Am. 1994;271081- 1096Google Scholar
4.
Goodacre  TEEWalker  CJJawad  ASJackson  AMBrough  MD Donor site morbidity following osteocutaneous free fibula transfer.  Br J Plast Surg. 1990;43410- 412Google ScholarCrossref
5.
Lee  EHGoh  JCHHelm  RPho  RWH Donor site morbidity following resection of the fibula.  J Bone Joint Surg Br. 1990;72129- 131Google Scholar
6.
Vail  TPUrbaniak  JR Donor-site morbidity with use of vascularized autogenous fibular grafts.  J Bone Joint Surg Am. 1996;78204- 211Google Scholar
7.
Anthony  JPRawnsley  JDBenhaim  PRitter  EFSadowsky  SHSinger  MI Donor leg morbidity and function after fibula free flap mandible reconstruction.  Plast Reconstr Surg. 1995;96146- 152Google ScholarCrossref
8.
Hidalgo  HA Fibula free flap: a new method of mandible reconstruction.  Plast Reconstr Surg. 1989;8471- 79Google ScholarCrossref
9.
Cheung  SWAnthony  JPSinger  MI Restoration of anterior mandible with the free fibula osteocutaneous flap.  Laryngoscope. 1994;104105- 113Google ScholarCrossref
10.
Jobe  MT Volkmann's contracture and compartment syndrome.  Campbell's Orthopaedics St Louis, Mo Mosby1992;3341- 3344Google Scholar
11.
Matsen  FAWinquist  RAKrugmire  RB Diagnosis and management of compartmental syndromes.  J Bone Joint Surg Am. 1980;62286- 291Google Scholar
Original Article
December 2000

The Fibula Osteocutaneous Flap in Head and Neck Reconstruction: A Critical Evaluation of Donor Site Morbidity

Author Affiliations

From the Department of Surgery, State University of New York at Stony Brook (Dr Shindo); the Division of Otolaryngology–Head and Neck Surgery, Department of Otolaryngology–Head and Neck Surgery, University of Southern California, Los Angeles (Dr Fong); and Department of Otolaryngology–Head and Neck Surgery, University of Iowa College of Medicine, Iowa City (Drs Funk and Karnell).

Arch Otolaryngol Head Neck Surg. 2000;126(12):1467-1472. doi:10.1001/archotol.126.12.1467
Abstract

Objectives  To (1) compare the complications and functional outcome of primary closure vs split-thickness skin grafting of the fibula osteocutaneous flap donor site, (2) identify patient-mix or treatment factors related to donor site complications, and (3) address early detection and management of donor site complications.

Design  Retrospective review and questionnaire study.

Setting  Two university tertiary referral centers.

Patients  Fifty-three patients (31 men and 22 women, ages 20 to 80 years) who underwent fibula osteocutaneous free tissue transfer between February 1992 and January 1997.

Main Outcome Measures  Minor complications; major complications; and postoperative function, including sensory and motor deficits, pain, swelling, temperature intolerance, and activities of daily living.

Results  Four patients developed major wound complications (group 1), 11 patients developed minor wound complications (group 2), and 38 patients had no wound complications (group 3). The donor site was closed primarily in 26 patients and with a split-thickness skin graft in the remaining 27 patients. Major wound complications developed in 3 patients (12%) who underwent primary closure and 1 patient (4%) who underwent split-thickness skin grafting. Minor wound complications developed in 7 (27%) of the patients who underwent primary closure and 4 patients (15%) who underwent split-thickness skin grafting. Three patients who had major complications had residual sensory or motor deficits that resulted in impaired gait or alteration in their daily activities. Comparing all patients with complications (groups 1 and 2) to patients with no complications (group 3) demonstrated an increased incidence of donor site complications in heavy smokers (P<.05) and a strong trend toward higher donor site complications in patients who underwent primary closure (P = .10). Although trends were identified, no significant differences were found in age, comorbid illnesses, alcohol use, preoperative laboratory values, operating time, tourniquet time, or skin paddle width.

Conclusions  A variety of patient-mix and operative factors are likely related to the development of donor site wound complications. Width of the skin paddle alone is not a reliable criterion for determining the need to skin graft the donor site. Primary closure tended to result in a higher rate of both major and minor wound complications compared with split-thickness skin grafting. Primary closure of fibula donor site defects should be undertaken if this can be accomplished with no tension along the suture line. If tension at the suture line is present, a skin graft should be strongly considered to minimize the possibility of a wound complication.

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