What is the price to pay for a free fibula flap? A systematic review of donor-site morbidity following free fibula flap surgery.

Background: A number of donor-site morbidities following free fibula flap surgery, although usually minor and transient, have been documented. The primary aim of this systematic review was to identify the incidence of donor-site morbidity after free fibula flap surgery, to discuss the causes of these morbidities, and to identify the best methods of prevention and treatment available.

Methods: A systematic search of the English and Chinese literature was performed of the PubMed, MEDLINE, Cochrane Library, and Embase databases. The study selection process was adapted from the PRISMA statement, and 42 articles complied with the study inclusion criteria.

Results: Forty-two relevant articles were included in the final analysis. Regarding early donor-site morbidity, the weighted mean incidences were as follows: wound infection, 1.07 percent; wound dehiscence, 7.0 percent; wound necrosis, 7.3 percent; delayed wound healing, 17.4 percent; partial skin graft loss, 8.1 percent; and total skin graft loss, 4.7 percent. The weighted mean incidence of early wound morbidity in surgical wounds that were closed primarily was 9.9 percent, compared with skin graft closure at 19.0 percent. In late donor-site morbidities, the weighted mean incidences were as follows: chronic pain, 6.5 percent; considerable gait abnormality, 3.9 percent; ankle instability, 5.8 percent; limited range of motion in the ankle, 11.5 percent; reduced muscle strength, 4.0 percent; claw toe, 6.1 percent; dorsiflexion of the great toe, 3.6 percent; and sensory deficit, 6.95 percent. The mean American Orthopaedic Foot and Ankle Society score was 85.5 percent.

Conclusion: One would expect to pay a low price for free fibula flap surgery with adequate surgical experience, refinements in surgical technique, and comprehensive postoperative care.

Clinical Question/level Of Evidence: Therapeutic, II.