VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam, The Netherlands.
VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam, The Netherlands.
J Plast Reconstr Aesthet Surg. 2014 Jul;67(7):986-91. doi: 10.1016/j.bjps.2014.03.005. Epub 2014 Mar 29.
Our aim was to evaluate the long-term morbidity of the hallux function after harvesting a free fibula flap. Special attention was given to the differences between patients who underwent the dissection of an osteo-cutaneous flap (without inclusion of the flexor hallucis longus (FHL) muscle) and patients who were treated with an osteo-myo-cutaneous (with inclusion of the FHL muscle).
During the period 1995-2009, 167 patients underwent an autologous mandible reconstruction using a free fibula flap. By the time of our investigation, 64 patients were deceased, 29 patients were lost to follow-up, 14 patients did not meet the inclusion criteria and 28 patients were unable or unwilling to come to the hospital. Thus, 32 patients were examined in this study. Combined flexion strength of the hallux flexors and range of motion (ROM) of the metatarsophalangeal (MTP) and interphalangeal (IP) joints were measured.
Hallux flexion strength tests showed a significant decrease in strength in the operated leg versus control, 28±16.6 versus 37±19.2 N/s (p=0.003). The ROM for the MTP was significantly lower for the donor leg than for the control leg: 26±12° versus 30±10° (p=0.024) for plantar flexion and 30±13° versus 37±11° (p<0.001) for dorsal flexion. In addition, the ROM for plantar flexion in the IP joint was significantly lower in the donor group. No significant differences were found when comparing reduction of flexion strength or reduction of ROM in the osteo-cutaneous versus osteo-myo-cutaneous harvest.
The main conclusion to be drawn from our results is that free fibula flap donor site morbidity in terms of hallux function is independent of the inclusion or exclusion of the FHL muscle in the flap.
Retrospective cohort or comparative study; case-control study; or systematic review of these studies.
本研究旨在评估游离腓骨皮瓣移植术后足拇功能的长期并发症，并特别关注行骨-皮瓣游离（不包含屈趾长肌(FHL)）与行骨-肌-皮瓣游离（包含 FHL 肌）患者之间的差异。
1995 年至 2009 年间，167 例患者接受游离腓骨皮瓣进行下颌骨重建。截至研究时，64 例患者死亡，29 例失访，14 例不符合纳入标准，28 例无法或不愿来院，最终纳入 32 例患者进行研究。测量拇趾屈肌联合跖趾（MTP）和近侧指间（IP）关节活动度的屈肌力量和活动范围（ROM）。
与健侧相比，患侧拇趾屈肌力量测试明显减弱，分别为 28±16.6N/s 和 37±19.2N/s（p=0.003）。MTP 跖屈和背屈的 ROM 均显著低于健侧：跖屈时分别为 26±12°和 30±10°（p=0.024），背屈时分别为 30±13°和 37±11°（p<0.001）。此外，IP 关节跖屈的 ROM 也显著降低。骨-皮瓣游离与骨-肌-皮瓣游离在屈肌力量下降或 ROM 下降方面无显著差异。
本研究结果表明，游离腓骨皮瓣供区在足拇功能方面的并发症与皮瓣是否包含 FHL 肌肉无关。
证据等级 III：回顾性队列或比较研究；病例对照研究；或对这些研究的系统回顾。
