From the Sections of Plastic Surgery and Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary; and Section of Plastic Surgery, Department of Surgery, King Saud bin Abdulaziz University for Health Sciences.
Plast Reconstr Surg. 2021 Dec 1;148(6):1007e-1011e. doi: 10.1097/PRS.0000000000008588.
Patient-reported outcomes regarding donor-site morbidity and quality of life for the fibula free flap in head and neck reconstruction patients have not been studied. The authors reviewed and identified patients who had undergone head and neck reconstruction using a fibula free flap (2011 to 2016). Patients were assessed via physical examination and two patient-reported outcomes questionnaires: the Foot and Ankle Outcome Score (score range, 0 to 100) and the Pain Disability Questionnaire (score range, 0 to 100). Quantitative data were analyzed with appropriate statistical tests. Semistructured interviews exploring donor-site challenges were performed and analyzed using thematic analysis. Seventeen patients agreed to participate. Their mean age was 62 years (range, 41 to 81 years). Mean follow-up was 38 months (range, 12 to 65 years). Mean perceived level of function compared to baseline was 67 percent. Mean scores for the Foot and Ankle Outcome Score subscales were 84.6 (pain), 80.5 (symptoms), 86.7 (activities of daily living), 67.7 (sport), and 65.6 (quality of life). The mean Pain Disability Questionnaire score was 26.3 (mild/moderate perceived disability). Higher perceived level of function was associated with higher Foot and Ankle Outcome Score values (pain, symptoms, and activities of daily living, p < 0.05). Donor limbs had decreased range of motion and manual muscle testing scores compared with their contralateral limbs (p < 0.05). Lack of ankle support and balance, resulting in limitations and aversions to daily and sporting activities, were the most common themes regarding donor-site challenges. In conclusion, patients who have undergone fibula free flap harvest struggle with ankle support and balance and face functional difficulties that have an impact on their quality of life. Multidisciplinary approaches for targeted rehabilitation after fibula free flap harvest should be explored to determine the impact on patients' quality of life.
患者报告的腓骨游离皮瓣用于头颈部重建的供区发病率和生活质量结果尚未得到研究。作者回顾并确定了 2011 年至 2016 年间使用腓骨游离皮瓣进行头颈部重建的患者。通过体格检查和两个患者报告的结果问卷评估患者：足部和踝关节结果评分（评分范围：0 至 100）和疼痛残疾问卷（评分范围：0 至 100）。使用适当的统计检验分析定量数据。进行了探索供区挑战的半结构式访谈，并使用主题分析进行了分析。17 名患者同意参与。他们的平均年龄为 62 岁（范围：41 至 81 岁）。平均随访时间为 38 个月（范围：12 至 65 年）。与基线相比，平均感知功能水平为 67%。足部和踝关节结果评分子量表的平均得分为 84.6（疼痛），80.5（症状），86.7（日常生活活动），67.7（运动）和 65.6（生活质量）。疼痛残疾问卷的平均得分为 26.3（轻度/中度感知残疾）。感知功能水平越高，足部和踝关节结果评分值越高（疼痛、症状和日常生活活动，p < 0.05）。供区肢体的活动范围和手动肌肉测试评分均低于其对侧肢体（p < 0.05）。供区挑战最常见的主题是缺乏踝关节支撑和平衡，导致日常和运动活动的限制和厌恶。总之，接受过腓骨游离皮瓣采集的患者在踝关节支撑和平衡方面存在困难，并面临影响其生活质量的功能困难。应探索腓骨游离皮瓣采集后的多学科综合康复方法，以确定对患者生活质量的影响。
