Evaluation of long-term functional donor-site morbidity after deep circumflex iliac crest artery bone flap harvest.

PURPOSE: Free flap surgery can be associated with donor-site morbidity. The purpose of this study was to analyze long-term functional outcomes at the donor site after deep circumflex iliac artery (DCIA) bone flap harvesting. METHODS: Fourteen patients (8 men and 6 women, mean age 53.9 years; range 22-87 years) with mandible resection (8 carcinomas, 4 ameloblastomas, 1 osteonecrosis, and 1 myxofibroma) and DCIA flap reconstruction were included in an observational study. Ranges of motion in the hip and lumbar spine, Harris hip score (HHS), jumping mechanography, chair rising, and balance testing were performed on a ground force reaction plate (Leonardo Mechanograph, Novotec Medical GmbH, Germany). The primary outcome was the Esslinger fitness index (EFI, maximum peak power in W/kg normalized to age and gender). RESULTS: Functional assessment was performed preoperatively and 29.0 months postoperatively (range 12-51 months). Mean DCIA flap length was 6.3 cm (range 3.3-10.1 cm). Jaw reconstruction was successful in all cases. HHS (99.2 vs. 97.7 points, P = .004) and all ranges of motion in the lumbar spine and hip joint except for dorsal extension were significantly reduced postoperatively (range -4° to -11.0°). There was no significant difference between pre- and postoperative EFI (77.9% vs. 74.28%, P = .591) and body sway (1.25 cm2 vs. 2.01 cm2 , P = .806). Sensory deficits (n = 5), load dependent pain (n = 3), and limitations of daily activities (n = 3) were subjective complaints. CONCLUSION: Functional donor site morbidity after DCIA harvesting can be expected to be low in the long-term.

Functional donor site morbidity longer than one year after fibula free flap: A prospective biomechanical analysis.

OBJECTIVES: The fibula free flap is the workhorse procedure for osseous reconstruction. The objective of this study was to investigate long-term functional outcomes of the harvesting site. PATIENTS AND METHODS: About 19 patients (10 male, 9 female, mean age 58.1 years) were available for the long-term analysis 13-51 months after surgery. Jumping mechanography and balance testing on a ground force reaction plate (Leonardo Mechanograph GFRP) were performed before and surgery. The Esslinger Fitness Index (EFI, maximum peak power in W/kg normalized for age and gender) was considered as primary endpoint. Secondary outcomes were maximum force, range of motion in the ankle joint, sensory limitations, the American Orthopedic Foot and Ankle Society Score (AOFAS-Score), and subjective perceptions. RESULTS: We found no significant difference between pre- and postoperative EFI (70.4% versus 66.0%, P = 0.07) and body sway (1.72 cm2 versus 2.60 cm2 , P = 0.093). The AOFAS-Score was reduced by 8.8 points (99.1 points versus 90.3 points, P < 0.001). Dorsal extenstion (31.6° versus 24.1°, P < 0.001) and flexion (32.3 versus 25.6° flexion, P = 0.011) were significantly reduced and 6 patients had chronic pain. CONCLUSIONS: Reduced peak power and balance ability seem to be reversible short-term effects after fibula harvesting. We recommend preoperative patient education and standardized protocols for physiotherapy.

Increasing the accuracy of mandibular reconstruction with free fibula flaps using functionalized selective laser-melted patient-specific implants: A retrospective multicenter analysis.

In this study, selective laser melted patient specific functional implants (PSFI) were utilised in combination with a fibula free flap, for mandible reconstruction. The shape and length of the PSFI, the shaping of fibula graft, its angulation and the length of the screws, were virtually planned before the surgery. Information, such as resection margin and screw lengths, were coded on the implant. 22 patients were reconstructed with PSFI and fibula transplantation. Data collected related to the size of the defect, pre- and postoperative intercondylar distance, ischemia time, time consumed to shape the fibula graft and complications. All patients were reconstructed as planned. Depending on the extension of the defect, the fibula grafts were shaped into different shapes, within 41.6 ± 4.9 min. The mean difference of pre- and post-operational condyle distances was 1.2 ± 1.4 mm. Postoperative complications such as wound healing disturbance and plate exposure occurred in 8 patients. All PSFIs remained within reconstruction sites during the follow up period. 8 out of the 22 patients had full dental rehabilitation with implants. Based on our results, the use of PSFIs in the reconstruction of mandibular segmental defects may contribute to a better clinical outcome. Further work will be required in order to evaluate their mechanical properties in detail.