An objective analysis of composite free flap donor site morbidity in head and neck surgery: Prospective series

Abstract

Background A poor evidence basis exists regarding the objective donor site morbidity associated with osseous free flap harvest. This study prospectively assessed the objective donor site morbidity associated with osseous free flap harvest for the fibula, scapula, and iliac crest (DCIA) donor sites. Methods A single‐site, prospective cohort clinical research study was conducted. Sixty‐four patients were recruited between 2017 and 2021. Patients were assessed using a donor site specific assessment tool pre‐operatively, and again >12 months post‐operatively. Results There was a significant reduction post‐operatively in assessment tool scores compared to the pre‐operative period for the fibula, scapula and DCIA. Females were more likely to report a greater reduction in Harris Hip Score post‐operatively compared to males. Conclusions The fibula, scapula, and DCIA donor sites are associated with reduced objective function post‐operatively compared to patient's pre‐operative baseline. The implications are least pronounced for the fibula.

Innovative Strategies in Microvascular Head and Neck Reconstruction

“…The search for the ideal donor site remains elusive, but likely there is no single donor site that is ideal, and the reconstructive microsurgeon must decide which donor site to use based on the extent and type of defect as well as the patient’s body habitus and available donor sites [ 80 ]. Similar considerations exist with bony reconstruction; however, the use of the fibula donor site in combination with CAD-CAM technology has largely supplanted other donor sites for mandible reconstruction [ 81 ]. Despite the reported advantages, judicious use and consideration of the limitations and costs of VSP are still important for the operating surgeon, who should critically evaluate and aim to improve outcomes even further [ 82 ].…”

Donor Limb Functional Restoration via a Novel Clinical Care Pathway following Fibula Free Flap Harvest for Head and Neck Reconstruction

“… 1 However, due to the complex nature of these reconstructive procedures, patients experience numerous physical and psychological impairments requiring interdisciplinary management and rehabilitation. 2 , 3 Unfortunately, there is no universal and validated approach to dealing with the impairments that are sequelae of this surgery. For example, we know these patients have strength and range of motion impairments, but we do not fully understand the specific qualitative and quantitative impacts such as walking speed, force production, or highest level of function achievable.…”

“… 4 Because these patients undergo surgical intervention across multiple sites, patients experience both short- and long-term physical impairments. 2 , 3 , 5 Deficits include, but are not limited to, activities of daily living; functional movement (eg, gait, jumping, balance); strength and range of motion in both the upper and lower extremities; and psychosocial outcomes, both internally and externally within their support circles. 6 , 7 Additionally, there is a lack of validated pre- and/or postoperative protocols for the management of these patients across disciplines.…”