Hostname: page-component-6766d58669-mzsfj Total loading time: 0 Render date: 2026-05-20T08:13:33.184Z Has data issue: false hasContentIssue false
  • English
  • Français

Subjective morbidity following fibular free flap reconstruction in head and neck cancer patients

Published online by Cambridge University Press:  24 July 2018

D M Sparkman ,
M R Simmons  and
Y J Patil
D M Sparkman
Affiliation:
Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center, Houston, USA
M R Simmons
Affiliation:
Department of Biostatistics and Bioinformatics, University of Cincinnati Medical Center College of Medicine, Ohio, USA
Y J Patil*
Affiliation:
Department of Otolaryngology Head and Neck Surgery, University of Cincinnati Medical Center College of Medicine, Ohio, USA
*
Author for correspondence: Dr Yash Patil, Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, ML no. 0528, Cincinnati, Ohio, USA E-mail: yash.patil@uc.edu Fax: +1 513 558 5203
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

This study aimed to evaluate the presence of subjective post-operative donor site morbidity after fibula free flap reconstruction in head and neck cancer patients, utilising three validated instruments: the 36-item Short Form Health Survey, the Short Musculoskeletal Function Assessment questionnaire and the Lower Limb Core Scale.

Methods

In this retrospective study, all head and neck cancer patients who underwent fibula free flap reconstruction between January 2009 and July 2014 were identified. All questionnaires and their respective subcomponents were scored.

Results

Twenty-one cases were included. Patients were found to have a higher Short Musculoskeletal Function Assessment bothersome index (22.42 vs 13.77, p = 0.03), a lower Short Form 36 Health Survey Physical Component Summary score (42.44 vs 50, p < 0.01) and a decreased Lower Limb Core Scale score (47.08 vs 90.52, p < 0.01), compared to US population norms. The Short Form 36 Health Survey Mental Component Summary scores and Short Musculoskeletal Function Assessment function index failed to demonstrate significant differences. Gender affected overall disability.

Conclusion

In this study, significant long-term disability was demonstrated after fibular flap reconstruction, as measured by the Lower Limb Core Scale.

Keywords

Head And Neck NeoplasmsFree Tissue FlapsFibulaReconstructive Surgical ProcedureLower Extremity

Information

Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 132 , Issue 8 , August 2018 , pp. 729 - 733
Copyright
Copyright © JLO (1984) Limited, 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

Dr Y J Patil takes responsibility for the integrity of the content of the paper

References

1Shepherd, KL, Fisher, SE. Prospective evaluation of quality of life in patients with oral and oropharyngeal cancer: from diagnosis to three months post-treatment. Oral Oncol 2004;40:751–7Google Scholar
2Taylor, GI, Miller, GD, Ham, FJ. The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg 1975;55:533–44Google Scholar
3Hidalgo, DA. Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg 1989;84:71–9Google Scholar
4Pototschnig, H, Schaff, J, Kovacs, L, Biemer, E, Papadopulos, NA. The free osteofasciocutaneous fibula flap: clinical applications and surgical considerations. Injury 2013;44:366–9Google Scholar
5Baj, A, Lovecchio, N, Bolzoni, A, Mapelli, A, Gianni, AB, Sforza, C. Stair ascent and descent in assessing donor-site morbidity following osteocutaneous free fibula transfer: a preliminary study. J Oral Maxillofac Surg 2015;73:184–93Google Scholar
6Ling, XF, Peng, X, Samman, N. Donor-site morbidity of free fibula and DCIA flaps. J Oral Maxillofac Surg 2013;71:1604–12Google Scholar
7Anthony, JP, Rawnsley, JD, Benhaim, P, Ritter, EF, Sadowsky, SH, Singer, MI. Donor leg morbidity and function after fibula free flap mandible reconstruction. Plast Reconstr Surg 1995;96:146–52Google Scholar
8Ling, XF, Peng, X. What is the price to pay for a free fibula flap? A systematic review of donor-site morbidity following free fibula flap surgery. Plast Reconstr Surg 2012;129:657–74Google Scholar
9McHorney, CA, Ware, JE Jr, Raczek, AE. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 1993;31:247–63Google Scholar
10Ware, JE, Kosinski, M, Bjorner, JB, Turner-Bowker, DM, Gandek, B, Maruish, ME. User's Manual for the SF-36v2 Health Survey, 2nd edn. Lincoln, RI: QualyMetric, 2007Google Scholar
11Swiontkowski, MF, Engelberg, R, Martin, DP, Agel, J. Short musculoskeletal function assessment questionnaire: validity, reliability, and responsiveness. J Bone Joint Surg Am 1999;81:1245–60Google Scholar
12Hunsaker, FG, Cioffi, DA, Amadio, PC, Wright, JG, Caughlin, B. The American Academy of Orthopaedic Surgeons outcomes instruments: normative values from the general population. J Bone Joint Surg Am 2002;84-A:208–15Google Scholar
13Johanson, NA, Liang, MH, Daltroy, L, Rudicel, S, Richmond, J. American Academy of Orthopaedic Surgeons lower limb outcomes assessment instruments. Reliability, validity, and sensitivity to change. J Bone Joint Surg Am 2004;86-A:902–9Google Scholar
14Monticelli, A, Ciclamini, D, Boffano, M, Boux, E, Titolo, P, Panero, B et al. Lower Limb Core Scale: a new application to evaluate and compare the outcomes of bone and soft-tissue tumours resection and reconstruction. Biomed Res Int 2014;2014:652141Google Scholar
15R Development Core Team. R: A Language and Environment for Statistical Computing. Vienna: R Foundation for Statistical Computing, 2008Google Scholar
16Tschiesner, U, Rogers, SN, Harreus, U, Berghaus, A, Cieza, A. Content comparison of quality of life questionnaires used in head and neck cancer based on the international classification of functioning, disability and health: a systematic review. Eur Arch Otorhinolaryngol 2008;265:627–37Google Scholar
17Asch, DA, Jedrziewski, MK, Christakis, NA. Response rates to mail surveys published in medical journals. J Clin Epidemiol 1997;50:1129–36Google Scholar
18de Graaf, MW, El Moumni, M, Heineman, E, Wendt, KW, Reininga, IH. Short Musculoskeletal Function Assessment: normative data of the Dutch population. Qual Life Res 2015;24:2015–23Google Scholar
19Momoh, AO, Yu, P, Skoracki, RJ, Liu, S, Feng, L, Hanasono, MM. A prospective cohort study of fibula free flap donor-site morbidity in 157 consecutive patients. Plast Reconstr Surg 2011;128:714–20Google Scholar
20Daniels, TR, Thomas, R, Bell, TH, Neligan, PC. Functional outcome of the foot and ankle after free fibular graft. Foot Ankle Int 2005;26:597–601Google Scholar
21Sagalongos, OS, Valerio, IL, Hsieh, CH, Kuo, YR, Wang, LY, Rong, LH et al. Qualitative and quantitative analyses of donor-site morbidity following suprafascial versus subfascial free fibula flap harvesting. Plast Reconstr Surg 2011;128:137–45Google Scholar
22Vittayakittipong, P. Donor-site morbidity after fibula free flap transfer: a comparison of subjective evaluation using a visual analogue scale and point evaluation system. Int J Oral Maxillofac Surg 2013;42:956–61Google Scholar
23Rogers, SN, Lakshmiah, SR, Narayan, B, Lowe, D, Brownson, P, Brown, JS et al. A comparison of the long-term morbidity following deep circumflex iliac and fibula free flaps for reconstruction following head and neck cancer. Plast Reconstr Surg 2003;112:1517–25Google Scholar
24Schardt, C, Schmid, A, Bodem, J, Krisam, J, Hoffmann, J, Mertens, C. Donor site morbidity and quality of life after microvascular head and neck reconstruction with free fibula and deep-circumflex iliac artery flaps. J Craniomaxillofac Surg 2017;45:304–11Google Scholar
25Zhu, J, Xiao, Y, Liu, F, Wang, J, Yang, W, Xie, W. Measures of health-related quality of life and socio-cultural aspects in young patients who after mandible primary reconstruction with free fibula flap. World J Surg Oncol 2013;11:250Google Scholar
26Vu, DD, Schmidt, BL. Quality of life evaluation for patients receiving vascularized versus nonvascularized bone graft reconstruction of segmental mandibular defects. J Oral Maxillofac Surg 2008;66:1856–63Google Scholar
27Zhang, X, Li, MJ, Fang, QG, Li, ZN, Li, WL, Sun, CF. Free fibula flap: assessment of quality of life of patients with head and neck cancer who have had defects reconstructed. J Craniofac Surg 2013;24:2010–13Google Scholar
28Ciocca, L, Tarsitano, A, Mazzoni, S, Gatto, MR, Marchetti, C, Scotti, R. Evaluation of masticatory efficiency and QoL improvements after prosthetic rehabilitation of mandibular cancer patients reconstructed with a fibula free flap. Int J Prosthodont 2015;28:418–24Google Scholar
29Brandao, TB, Vechiato Filho, AJ, Prado Ribeiro, AC, Gebrin, EM, Bodard, AG, da Silva, DP et al. Evaluation of use of acrylic resin-based surgical guide in the function and quality of life provided by mandibular prostheses with microvascular free fibula flap: a four-year, randomized, controlled trial. J Prosthet Dent 2016;116:457–63 e452Google Scholar
30Al-Hayder, S, Elberg, JJ, Charabi, B. Clinical outcome and health-related quality-of-life following microsurgical reconstruction in patients with oral and oropharyngeal cancer. Acta Otolaryngol 2017;137:541–5Google Scholar