Donor-site morbidity following osteocutaneous free fibula transfer: longitudinal analysis of gait performance

Publication date: Available online 2 November 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Riccardo Di Giuli, Matteo Zago, Giada A. Beltramini, Maria Ludovica Pallotta, Alessandro Bolzoni, Alessandro Baj, Aldo Bruno Giannì, Chiarella Sforza

Abstract

Purpose

To evaluate donor site clinical morbidity and changes in kinematic gait parameters after the harvest of a vascularized free fibula flap (VFFF) for facial reconstruction.

Methods

Fourteen patients (50 ± 15 years) were enrolled in a longitudinal study. Every patient underwent a double evaluation performing a pre-surgical and a 6-months post-surgical assessment. Subjective donor-site evaluation was carried out through non-structured clinical questioning about pain, paresthesia, walking ability, restrictions in activity. Further subjective evaluations were assessed through the Western Ontario and McMaster Osteoarthritis Index (WOMAC(®)) and the Point Evaluation System for Lower Extremity Fibulectomy (PESLEF). A clinical evaluation on the donor site assessed muscular deficits, sensibility disturbance and wound healing. Temporal and spatial kinematic parameters were measured through gait analysis during overground walking at a comfortable speed.

Results

Post-surgical clinical examinations detected one patient affected by neurological disorder and three patients with donor-site pain. Ten patients (71%) declared no residual alterations in the operated leg. On average, the WOMAC score was 367/2400 and the PESLEF score was 19/24. Pre-post surgical gait analysis comparison showed no significant differences in gait parameters except for a 6% reduction of the double support phase. Stance values were higher in the operated limb in both evaluations (+1.3% presurgey; +1.8% postsurgery). No alterations were detected in the range of motion of lower limbs joints.

Conclusion

Considering the slight modification of the gait pattern, that is not usually perceived by patients, VFFF harvest was generally associated to successful functional and subjective outcomes of the donor site.

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