Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China.
Department of Anesthesiology, School of Stomatology, China Medical University, Shenyang, People's Republic of China.
Oral Oncol. 2020 Jan;100:104489. doi: 10.1016/j.oraloncology.2019.104489. Epub 2019 Nov 27.
Free fibular flaps (FFFs) have been widely used in mandibular reconstruction. It is still unclear whether retaining flexor hallucis longus (FHL) is needed for flaps. This study introduces a comparison in quality of life and donor-site function between those who have and haven't harvested FHL with FFF.
Patients with FFFs were single-blind-randomly assigned into the FHL group or nFHL group. Patients were followed up preoperatively and 1, 3 and 6 months postoperatively via subjective evaluations (SF-36/AOFAS) and objective evaluation s(muscle strength and range of motion). Patients' hospitalization and intraoperative information, donor site morbidity were recorded.
Each group had 15 patients. The flap harvesting time in FHL group was shorter significantly than nFHL group (125.9 ± 24.8 min vs 146.7 ± 29.9 min, P = 0.048). There were no significant differences in hospitalization information such as operation time, hospitalization days and cost. Donor site morbidities at 1, 3 and 6 months postoperatively showed no significant differences except for the presence of claw toes (nFHL group > FHL group, 40% vs 0, P = 0.017; 53.3% vs 6.7%, P = 0.014; 60.0% vs 13.3%, P = 0.021). There were no significant differences in SF-36 and AOFAS scores. There were no significant differences in muscle strength and range of motion.
Excision of the FHL lowered the flap harvesting time. It did not increase donor site morbidity. The impacts on patients' quality of life and foot function were the same. The surgeons can use the FHL without considering the influence on patients if not retaining the FHL.
游离腓骨瓣（FFFs）已广泛应用于下颌骨重建。对于是否需要保留腓骨长肌（FHL）用于皮瓣仍存在争议。本研究旨在比较带与不带 FHL 的 FFF 重建后患者的生活质量和供区功能。
将接受 FFF 患者采用单盲随机分组法分为 FHL 组或 nFHL 组。患者分别在术前、术后 1、3、6 个月接受主观评估（SF-36/AOFAS）和客观评估（肌力和关节活动度）。记录患者的住院和术中信息、供区并发症。
每组各 15 例患者。FHL 组皮瓣切取时间明显短于 nFHL 组（125.9±24.8 min 比 146.7±29.9 min，P=0.048）。两组患者的手术时间、住院天数和费用等住院信息差异无统计学意义。除爪状趾外（nFHL 组比 FHL 组更常见，40%比 0，P=0.017；53.3%比 6.7%，P=0.014；60.0%比 13.3%，P=0.021），两组术后 1、3、6 个月的供区并发症差异无统计学意义。SF-36 和 AOFAS 评分差异无统计学意义。两组患者的肌力和关节活动度差异无统计学意义。
切除 FHL 可缩短皮瓣切取时间，且不会增加供区并发症。对患者生活质量和足部功能的影响相同。如果不保留 FHL，外科医生可以在不影响患者的情况下使用 FHL。
