Ershadifar Soroush, Colback Angela, Basmaci Ugur Nur, Wilson Machelle, Birkeland Andrew C, Silverman Dustin A
Department of Otolaryngology-Head and Neck Surgery University of California-Davis Sacramento California USA.
Department of Otorhinolaryngology-Head and Neck Surgery McGovern Medical School, The University of Texas Health Science Center at Houston Houston Texas USA.
OTO Open. 2025 May 5;9(2):e70126. doi: 10.1002/oto2.70126. eCollection 2025 Apr-Jun.
The fibula free flap (FFF) remains the workhorse flap for head and neck defects necessitating osteocutaneous reconstruction. Although lower extremity angiography, ultrasound (US), and other vascular studies are routinely used for fibula assessment and patient selection, predictors of donor-site morbidity following harvest remain poorly understood. We sought to investigate the factors associated with FFF donor-site complications.
Retrospective analysis of patients at a tertiary care center.
Tertiary care center.
In total, 119 patients undergoing FFF reconstruction during the years 2012 to 2022 were included. Multivariable logistic regression was used to identify independent predictors of soft-tissue donor-site wound complications.
A total of 48 (40.3%) patients developed a donor-site wound complication with an average time to diagnosis of 24 days (±16) following surgery. In multivariable regression, history of alcohol use disorder ( = .0083) and method of donor-site closure ( = .0368) were independent predictors of donor-site wound complications. Split-thickness skin graft closure was associated with a 146% increased odds of wound complications (odds ratio [OR] = 2.46, 1.11-5.43, 95% confidence interval). Patient age, body mass index, Charlson comorbidity index, skin paddle size, and Doppler US characteristics were not predictive of postoperative donor-site morbidity.
Predictors of FFF donor-site wound complications included history of alcohol abuse and method of donor-site closure. This study highlights unique lower extremity Doppler US findings in patients undergoing FFF reconstruction in addition to modifiable risk factors associated with fibula donor-site morbidity and soft-tissue complications. Our findings underscore the need to critically evaluate wound closure techniques in this population.
对于需要进行骨皮瓣重建的头颈部缺损，游离腓骨瓣（FFF）仍然是主要的皮瓣。尽管下肢血管造影、超声（US）及其他血管检查常用于腓骨评估和患者选择，但腓骨切取后供区并发症的预测因素仍知之甚少。我们旨在研究与FFF供区并发症相关的因素。
对一家三级医疗中心的患者进行回顾性分析。
三级医疗中心。
纳入2012年至2022年期间接受FFF重建的119例患者。采用多变量逻辑回归分析确定软组织供区伤口并发症的独立预测因素。
共有48例（40.3%）患者发生供区伤口并发症，术后平均诊断时间为24天（±16天）。在多变量回归分析中，酒精使用障碍史（P = 0.0083）和供区闭合方法（P = 0.0368）是供区伤口并发症的独立预测因素。采用中厚皮片移植闭合供区与伤口并发症发生几率增加146%相关（优势比[OR]=2.46，1.11 - 5.43，95%置信区间）。患者年龄、体重指数、查尔森合并症指数、皮瓣大小和多普勒超声特征不能预测术后供区并发症。
FFF供区伤口并发症的预测因素包括酒精滥用史和供区闭合方法。本研究不仅强调了与腓骨供区发病率和软组织并发症相关的可改变风险因素，还突出了接受FFF重建患者独特的下肢多普勒超声检查结果。我们的研究结果强调了对此类人群伤口闭合技术进行严格评估的必要性。
