Evaluation of Donor Leg Morbidity and Function Following Bilateral Fibula Osteoseptocutaneous Free Tissue Transfer

The donor site morbidity from harvesting of a free fibular osteoseptocutaneous flap in one leg has been previously evaluated and considered minimal. The purpose of this reported study was to review the long-term donor site morbidity associated with the removal of the fibula from both legs.

There were 31 consecutive patients undergoing mandible reconstruction utilizing bilateral fibulas as the donor sites for osteoseptocutaneous free tissue transfer over a period of 14 years (1990–2004). Twelve patients available were interviewed for evaluation of subjective symptoms in the donor leg, including pain, paresthesia, walking ability, restriction in activity, gait alteration, and aesthetic result. Seven patients had taken gait analysis and balance test using the Balance Master system. The results of these objective assessment were compared with those of age-matched controls (n = 8).

Most patients responded with little complaint in the interview. The most common complaints were slight decrease in walking ability (4/12), minor restriction in activity (3/12), and minimal paresthesia (3/12). There were no significant differences in gait analysis between those who had undergone bilateral fibular harvest and the control group. In the balance test, there were no significant differences in reaction time and movement velocity between the study and control groups (p > 0.05). However, there were statistically significant differences in right backward direction control, maximum stability (sway of surface), and ankle strategy (p < 0.05).

Although there were some subjective complaints or objective signs following bilateral free fibular harvest, long-term follow-up at the donor site revealed minimal morbidity which was well-accepted by the patients.