Morphologic assessment of mandibular reconstruction by free fibula flap and donor-site functional impairment in a series of 23 patients

Abstract

Introduction: Micro-anastomosed free fibula flap is an attitude of choice in mandibular defect repair in oncology, enabling effective functional rehabilitation. The present study assessed donor and recipient site morphology and donor-site sequelae. Patients and methods: The study consecutively recruited patients undergoing mandibular resection with free fibula flap reconstruction in our centre between December 2003 and September 2008. Assessment on adapted scales was performed by two independent expert physicians and patient self-assessment. Results: Out of 49 mandibular reconstructions performed in the centre over the 5-year study period, 23 patients free of recurrence were included. Satisfaction rates were 73% for the recipient site and 70% for the donor-site, with patient/expert agreement of 47% and 49.5% respectively. Donor-site impact was mainly in terms of reduced ankle range of motion (43% of cases) and flexion strength (39%) and discomfort in running (35%) and walking (26%). Risk factors for dissatisfaction were more than 5% weight loss at admission for recipient site dissatisfaction (patient, P = 0.012; expert, P = 0.046), and skin graft for donor-site dissatisfaction (patient, P = 0.04; expert, P = 0.035). Conclusion: Free fibula flap was associated with high satisfaction rates, but non-negligible donor-site impact. © 2012 Elsevier Masson SAS.