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Compartment syndrome in a free fibula osteocutaneous flap donor site
M Saleem1, F Hashim, M Babu Manohar
1Section of Otolaryngology-Head and Neck Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Insights
Free fibula flaps are generally safe, but compartment syndrome can occur in children. Primary closure of the donor site, even with a narrow flap, may require skin grafting to prevent complications.
Area of Science:
- Orthopedic Surgery
- Microsurgery
- Pediatric Surgery
Background:
- Free fibula flaps are a common reconstructive method.
- Donor site morbidity is typically low.
Observation:
- A 15-year-old boy developed compartment syndrome after primary closure of a 4 cm wide fibula flap donor site.
- This complication occurred despite the relatively narrow skin paddle width.
Findings:
- Primary closure of free fibula flap donor sites in children can lead to major complications like compartment syndrome.
- The width of the skin paddle may not be the sole determinant of closure tension.
Implications:
- Consider skin grafting for free fibula flap donor sites in pediatric patients, regardless of flap width, if closure is tight.
- This recommendation aims to prevent serious donor site morbidity in children undergoing microvascular reconstruction.
Abstract:
Donor site morbidity for free fibula microvascular flaps is generally reported to be low and considered to be minor. We describe a case where the major complication of compartment syndrome occurred in a 15-year-old boy when the donor site defect was closed primarily after taking a skin paddle with a width of 4 cm. We recommend that when harvesting free fibula flaps in children, skin grafting of donor site should be considered irrespective of the width of the flap, if there is any doubt about the tightness of the closure.