Functional outcome of the foot and ankle after free fibular graft

The vascularized fibular bone graft (VFBG) is one of most common grafts used for free flap transfer. There have been no reports in the literature evaluating the functional outcome of the foot and ankle after a VFBG using validated functional outcome measures. In addition, most of the patients in published studies have had contralateral or ipsilateral lower limb pathology. The purpose of this study was to evaluate the functional outcome of the foot and ankle after a VFBG using validated functional outcome measures in patients with no preexisting lower limb pathology.

We conducted a retrospective analysis of our health center database and identified 28 patients who underwent free flap transfer for maxillofacial reconstruction. Patients were contacted by phone and mailed functional questionnaire packages. Functional outcome assessments were obtained through the use of the following validated functional outcome instruments: the Short Form-36 (SF-36), the Functional Foot Index (FFI), and the lower limb component of the Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS). A matched student t-test was used to compare the experimental limb to the appropriate control group.

The response rate was 77%. The incidence of wound complications was 23% (five of 22). Two of the five were caused by wound dehiscence, and three were caused by infection. There was an 18% incidence of clawing of the great toe. The SF-36 scores were not significantly different between the VFBG cohort and the control group. There was a statistically significant difference in FFI scores for all three categories: pain (p = 0.01), disability (p = 0.03), and activity limitation (p = 0.01). Nine patients (41%) were dissatisfied with their foot and ankle function at 3.1 years.

The VFBG is an ideal source for a free flap. The impact of the procedure on overall patient health is relatively minimal. However, there is a significant deleterious effect on foot and ankle function.