Neuropathic pain at the donor-site following free fibula flap harvest: A multicenter study

The free fibula flap (FFF) is widely used and considered the workhorse flap for osteocutaneous head and neck reconstruction. Donor-site morbidity is considered to be low and mild, and has therefore received little attention. Although sensory deficits and chronic pain have been reported in the donor-site, the incidence of neuropathic pain remains unclear. This study aimed to identify the incidence and prognostic factors associated with neuropathic pain at the donor-site following FFF harvest and investigate its impact on leg function and quality of life.

In this multicenter, cross-sectional study, 150 patients who underwent FFF surgery between 2010-2020 were included. Baseline characteristics were collected. All patients received questionnaires to measure self-reported pain (Doleur Neuropathique 4 and visual analog scale Pain), leg function (Lower Extremity Functional Scale), and quality of life (EuroQol-5D). Multivariable regression analysis was used to identify prognostic factors associated with the outcomes.

A total of 82 patients completed the questionnaires. Neuropathic pain was present in 21% of the patients. Multivariable analysis revealed that donor-site complications (p=0.025) and younger age (p=0.003) were independently associated with neuropathic pain. No difference in neuropathic pain incidence was found between primary and skin graft closure (p=0.54). Patients with neuropathic pain showed a significantly poorer quality of life (p=0.01).

One-fifth of all patients experienced neuropathic pain at the donor-site following FFF harvest. Younger patients and patients with donor-site complications are more prone to developing neuropathic pain. Future research should focus on analyses of surgical factors and optimalization of wound care to reduce the incidence of neuropathic pain.