Houston, Texas From the Departments of Plastic Surgery and Biostatistics, University of Texas M. D. Anderson Cancer Center.
Plast Reconstr Surg. 2011 Sep;128(3):714-720. doi: 10.1097/PRS.0b013e318221dc2a.
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.
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.
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.
Fibula free flap harvest is associated with a high rate of complications, but the majority of patients have no long-term functional limitations.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, IV.
尽管腓骨游离皮瓣是头颈部重建中首选的骨瓣，但供区并发症仍然是一个关注点。作者的目的是评估并发症的潜在危险因素，以及伤口闭合类型和术后早期活动时间是否会对短期和长期并发症的发生产生影响。
对 157 例连续行腓骨游离皮瓣修复头颈部缺损的患者进行前瞻性供区并发症队列研究。
31.2%的患者发生围手术期供区并发症，包括皮片移植失败（15%）、蜂窝织炎（10%）、伤口裂开（8%）和脓肿（1%）。术前化疗（p=0.02）与并发症增加相关。原发性和皮片移植伤口闭合之间的并发症发生率无显著差异（p=0.59）。早期活动时间与并发症的发生无关（p=0.41）。17%的患者发生长期并发症，包括下肢无力（8%）、踝关节不稳定（4%）、大脚趾挛缩（9%）和踝关节活动度降低（12%）。围手术期并发症、皮瓣类型和闭合技术的发生与长期并发症均无显著相关性。功能上，96%的患者恢复到术前的步行活动水平。步行状态的下降都可以归因于供区并发症以外的原因。
腓骨游离皮瓣采集相关并发症发生率高，但大多数患者无长期功能受限。
临床问题/证据水平：风险，IV。
