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A Prospective Cohort Study of Fibula Free Flap Donor-Site Morbidity in 157 Consecutive Patients

Momoh, Adeyiza O. M.D.; Yu, Peirong M.D.; Skoracki, Roman J. M.D.; Liu, Suyu M.S.; Feng, Lei M.S.; Hanasono, Matthew M. M.D.

Plastic and Reconstructive Surgery: September 2011 - Volume 128 - Issue 3 - p 714–720
doi: 10.1097/PRS.0b013e318221dc2a
Reconstructive: Lower Extremity: Original Articles

Background: Although the fibula free flap is preferred for bony head and neck reconstruction, donor-site morbidity remains a concern. The authors' goal was to evaluate potential risk factors for complications and whether the type of wound closure and timing of postoperative ambulation had an effect on the development of short- and long-term morbidities.

Methods: A prospective cohort study of donor-site morbidity was performed in 157 consecutive patients who underwent fibula free flap reconstruction for head and neck defects.

Results: Perioperative donor-site complications occurred in 31.2 percent of patients, including skin graft loss (15 percent), cellulitis (10 percent), wound dehiscence (8 percent), and abscess (1 percent). Preoperative chemotherapy (p = 0.02) was associated with increased complications. No significant difference in complication rates was observed between primary and skin graft wound closure (p = 0.59). The timing of ambulation was not related to the development of complications (p = 0.41). Long-term morbidities occurred in 17 percent of patients and included leg weakness (8 percent), ankle instability (4 percent), great toe contracture (9 percent), and decreased ankle mobility (12 percent). The occurrence of perioperative complications, flap type, and closure technique were not significantly associated with long-term morbidities. Functionally, 96 percent of patients returned to their preoperative level of ambulatory activity. Decreases in ambulatory status could all be ascribed to causes other than donor-site morbidity.

Conclusion: Fibula free flap harvest is associated with a high rate of complications, but the majority of patients have no long-term functional limitations.


Houston, Texas

From the Departments of Plastic Surgery and Biostatistics, University of Texas M. D. Anderson Cancer Center.

Received for publication December 2, 2010; accepted March 18, 2011.

Presented at the 89th Annual Meeting of the American Association of Plastic Surgeons, in San Antonio, Texas, March 20 through 23, 2010.

Disclosure: The authors have no commercial associations or financial disclosures that might pose or create a conflict of interest with information presented in this article. No funding was received for the work presented in this article.

Matthew M. Hanasono, M.D.; Department of Plastic Surgery, Unit 443, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030,

©2011American Society of Plastic Surgeons