Chan Tyler G, Rosado Aaron, Goyal Subir, Irizarry Rachel, Owen Robert J, Baddour Harry Michael, Boyce Brian, Kaka Azeem, El-Deiry Mark W, Gross Jennifer H
Emory University School of Medicine Atlanta Georgia USA.
Biostatistics Shared Resource Winship Cancer Institute Emory University Atlanta Georgia USA.
OTO Open. 2025 Jan 10;9(1):e70069. doi: 10.1002/oto2.70069. eCollection 2025 Jan-Mar.
Complex ablative maxillary and mandibular defects often require osseous free flap reconstruction. Workhorse options include the fibula, scapula, and osteocutaneous radial forearm flap (OCRFF). The choice of donor site for harvest should be driven not only by reconstructive goals but also by donor site morbidity. The goal of this study is to evaluate the long-term postoperative musculoskeletal morbidity at the donor site after osseous free flap harvest.
Cohort study and cross-sectional analysis.
A retrospective review of patients who underwent free flap harvest at 1 of the 3 donor sites from 2015 through 2021 was performed. An additional cross-sectional analysis at ≥1 year postoperatively was performed from 2021 to 2022 using validated patient-reported orthopedic surveys: Disabilities of the Arm, Shoulder, and Hand for scapula or OCRFF harvest, and Foot and Ankle Ability Measure for fibula harvest.
Single, high-volume tertiary care institution.
Among 731 eligible patients, 162 (22.1%) answered the telephone surveys and were included. Functional differences between operated and nonoperated sides were 18.5% (scapula, n = 33), 13.5% (OCRFF, n = 29), and 10% (fibula, n = 98). Postoperative physical therapy (for all donor sites), ipsilateral neck dissection (for scapula and OCRFF), and extent of bony resection (for OCRFF) were not factors associated with long-term morbidity. Acute donor site complications were most common in fibula patients and were associated with worse long-term functional outcomes (7.5% difference; 95% confidence interval, -14.0 to -1; = .03).
There is acceptable long-term musculoskeletal morbidity at the donor site after osseous free flap harvest, and patients should be counseled appropriately.
复杂的上颌骨和下颌骨消融性缺损通常需要游离骨瓣重建。常用的选择包括腓骨、肩胛骨和桡骨前臂骨皮瓣（OCRFF）。供区的选择不仅应依据重建目标，还应考虑供区并发症。本研究的目的是评估游离骨瓣切取术后供区的长期肌肉骨骼并发症。
队列研究和横断面分析。
对2015年至2021年期间在3个供区之一接受游离瓣切取的患者进行回顾性研究。2021年至2022年，在术后≥1年时使用经过验证的患者报告的骨科调查问卷进行额外的横断面分析：用于肩胛骨或OCRFF切取的手臂、肩部和手部功能障碍问卷，以及用于腓骨切取的足踝功能测量问卷。
单一的、大容量的三级医疗机构。
在731例符合条件的患者中，162例（22.1%）回复了电话调查并被纳入研究。手术侧与非手术侧的功能差异分别为18.5%（肩胛骨，n = 33）、13.5%（OCRFF，n = 29）和10%（腓骨，n = 98）。术后物理治疗（所有供区）、同侧颈部清扫术（肩胛骨和OCRFF）以及骨切除范围（OCRFF）均不是与长期并发症相关的因素。急性供区并发症在腓骨患者中最为常见，且与更差的长期功能结果相关（差异7.5%；95%置信区间，-14.0至-1；P = 0.03）。
游离骨瓣切取术后供区存在可接受的长期肌肉骨骼并发症，应向患者进行适当的咨询。
