Long-Term Postoperative Donor Site Musculoskeletal Morbidity after Osseous Free Flap Harvest

Complex ablative maxillary and mandibular defects often require osseous free flap reconstruction. Workhorse options include the fibula, scapula, and osteocutaneous radial forearm flap (OCRFF). The choice of donor site for harvest should be driven not only by reconstructive goals but also by donor site morbidity. The goal of this study is to evaluate the long-term postoperative musculoskeletal morbidity at the donor site after osseous free flap harvest.

Cohort study and cross-sectional analysis.

A retrospective review of patients who underwent free flap harvest at 1 of the 3 donor sites from 2015 through 2021 was performed. An additional cross-sectional analysis at ≥1 year postoperatively was performed from 2021 to 2022 using validated patient-reported orthopedic surveys: Disabilities of the Arm, Shoulder, and Hand for scapula or OCRFF harvest, and Foot and Ankle Ability Measure for fibula harvest.

Single, high-volume tertiary care institution.

Among 731 eligible patients, 162 (22.1%) answered the telephone surveys and were included. Functional differences between operated and nonoperated sides were 18.5% (scapula, n = 33), 13.5% (OCRFF, n = 29), and 10% (fibula, n = 98). Postoperative physical therapy (for all donor sites), ipsilateral neck dissection (for scapula and OCRFF), and extent of bony resection (for OCRFF) were not factors associated with long-term morbidity. Acute donor site complications were most common in fibula patients and were associated with worse long-term functional outcomes (7.5% difference; 95% confidence interval, -14.0 to -1; P = .03).

There is acceptable long-term musculoskeletal morbidity at the donor site after osseous free flap harvest, and patients should be counseled appropriately.