Patient-Reported Donor Site Quality of Life Outcomes Following Fibula Free Flap Reconstruction

Study Design: Retrospective cohort study. Objective: To (1) assess post-operative quality of life (QOL) and functional outcomes of fibula free flap (FFF) donor sites, (2) examine the incidence of post-operative claw toe deformities (CTDs) following FFF harvest, and (3) assess the effect of flexor hallicus longus (FHL) muscle preservation on the incidence of post-operative CTDs. Methods: Patients aged 18 years or older and at least 6 months from FFF reconstructive surgery completed the Manchester-Oxford Foot Questionnaire (MOXFQ)and the Short-form 36 (SF-36) Questionnaire. The incidence of post-operative CTDs reported by respondents was calculated. We assessed the associations between FHL preservation at time of surgery and QOL and functional outcomes, including the development of post-operative CTDs. Results: Sixty patients completed questionnaires at a mean of 38.3 months from surgery. The cohort consisted of 28 patients in whom the FHL muscle and nerve were preserved and 32 patients in whom they were not. Among respondents, 23.3% (14/60) reported post-operative CTDs. FHL status was not associated with post-operative CTDs or with worse scores in the domains of pain (p = 0.612), walking/standing (p = 0.431), or social functioning (p = 0.400). Overall, majority reported high post-operative QOL. Conclusions: While majority of patients who undergo FFF reconstruction can expect good long-term donor site QOL and functional outcomes, there are risks of functional impairment, including post-operative CTDs. Preservation of FHL muscle did not affect post-operative QOL outcomes or the incidence of CTDs. These data can inform patient QOL expectations following FFF harvest.