Donor Site Morbidity Assessment Using Elastography Following Peroneal Artery-Based Flap Harvest: A Pilot Study

Peroneal artery-based free flaps, including fibula and peroneal flaps, are commonly used in reconstructive surgeries. Despite their clinical utility, donor site morbidity remains a concern. Elastography is a non-invasive imaging technique that quantifies the elasticity or stiffness of soft tissues. This study aimed to utilize elastography to assess muscle stiffness changes at donor sites following peroneal artery-based flap harvest.

Between 2020 and 2022, nine patients underwent peroneal artery-based flap reconstruction for head and neck defects. Donor site morbidity was evaluated using elastography and American Orthopedic Foot and Ankle Society (AOFAS) scores at multiple time points: preoperatively, and at 1 month, 3 months, and 6 months postoperatively. Paired t-tests were used to compare preoperative and postoperative measurements at the flap donor site.

Six of the nine patients completed all postoperative evaluations. Analysis revealed that only the soleus muscle demonstrated a statistically significant increase in stiffness on elastography at the 6-month postoperative assessment (medial soleus: axial measurements increased from 51.5 ± 41.4 kPa preoperatively to 107.9 ± 75.4 kPa postoperatively, p = 0.04; lateral soleus: axial measurements increased from 65.5 ± 42.2 kPa preoperatively to 76.7 ± 43.1 kPa postoperatively, p = 0.04). However, no statistically significant differences were observed between the preoperative and 6-month postoperative AOFAS functional scores.

Peroneal artery-based flap harvest did not result in clinically significant functional impairment at the donor site six months postoperatively, despite objective increases in soleus muscle stiffness detected by elastography.