Browse > Article
http://dx.doi.org/10.5999/aps.2017.01592

Osteocutaneous flaps for head and neck reconstruction: A focused evaluation of donor site morbidity and patient reported outcome measures in different reconstruction options  

Kearns, Marie (Academic Plastic Surgery, Barts and the London School of Medicine and Dentistry)
Ermogenous, Panagiotis (Academic Plastic Surgery, Barts and the London School of Medicine and Dentistry)
Myers, Simon (Academic Plastic Surgery, Barts and the London School of Medicine and Dentistry)
Ghanem, Ali Mahmoud (Academic Plastic Surgery, Barts and the London School of Medicine and Dentistry)
Publication Information
Archives of Plastic Surgery / v.45, no.6, 2018 , pp. 495-503 More about this Journal
Abstract
With significant improvements in success rates for free flap reconstruction of the head and neck, attention has turned to donor site morbidity associated with osteocutaneous free flaps. In this review, we address the morbidity associated with harvest of the four most commonly used osteocutaneous flaps; the free fibula flap, the scapula flap, the iliac crest flap and the radial forearm flap. A comprehensive literature search was performed to identify articles relevant to donor site morbidity for these flaps. We assessed morbidity in terms of incidence of delayed healing, chronic pain, aesthetic outcomes, site specific complications and patient satisfaction/quality of life. Weighted means were calculated when sufficient studies were available for review. The radial forearm and free fibula flaps are associated with high rates of delayed healing of approximately 20% compared to the scapular (<10%) and iliac flaps (5%). The radial forearm flap has higher rates of chronic pain (16.7%) and dissatisfaction with scar appearance (33%). For the majority of these patients harvest of one of these four osteocutaneous does not limit daily function at long-term follow-up. The scapular osteocutaneous flap is associated with the lowest relative morbidity and should be strongly considered when the recipient defect allows. The radial forearm is associated with higher morbidity in terms of scarring, fractures, chronic pain and wrist function and should not be considered as first choice when other flap options are available.
Keywords
Free tissue flaps; Mandibular reconstruction; Quality of life; Postoperative complications;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
연도 인용수 순위
1 Pototschnig H, Schaff J, Kovacs L, et al. The free osteofasciocutaneous fibula flap: clinical applications and surgical considerations. Injury 2013;44:366-9.   DOI
2 Valentini V, Gennaro P, Aboh IV, et al. Iliac crest flap: donor site morbidity. J Craniofac Surg 2009;20:1052-5.   DOI
3 Arganbright JM, Tsue TT, Girod DA, et al. Outcomes of the osteocutaneous radial forearm free flap for mandibular reconstruction. JAMA Otolaryngol Head Neck Surg 2013; 139:168-72.   DOI
4 Shnayder Y, Tsue TT, Toby EB, et al. Safe osteocutaneous radial forearm flap harvest with prophylactic internal fixation. Craniomaxillofac Trauma Reconstr 2011;4:129-36.   DOI
5 Choi N, Cho JK, Jang JY, et al. Scapular tip free flap for head and neck reconstruction. Clin Exp Otorhinolaryngol 2015; 8:422-9.   DOI
6 Papadopulos NA, Schaff J, Sader R, et al. Mandibular reconstruction with free osteofasciocutaneous fibula flap: a 10 years experience. Injury 2008;39 Suppl 3:S75-82.
7 Bodde EW, de Visser E, Duysens JE, et al. Donor-site morbidity after free vascularized autogenous fibular transfer: subjective and quantitative analyses. Plast Reconstr Surg 2003;111:2237-42.   DOI
8 Farhadi J, Valderrabano V, Kunz C, et al. Free fibula donor-site morbidity: clinical and biomechanical analysis. Ann Plast Surg 2007;58:405-10.   DOI
9 Yang W, Zhao S, Liu F, et al. Health-related quality of life after mandibular resection for oral cancer: reconstruction with free fibula flap. Med Oral Patol Oral Cir Bucal 2014;19:e414-8.
10 Maciejewski A, Szymczyk C. Fibula free flap for mandible reconstruction: analysis of 30 consecutive cases and quality of life evaluation. J Reconstr Microsurg 2007;23:1-10.   DOI
11 Garrett A, Ducic Y, Athre RS, et al. Evaluation of fibula free flap donor site morbidity. Am J Otolaryngol 2006;27:29-32.   DOI
12 Mojallal A, Besse JL, Breton P. Donor site morbidity after free fibula flap: report of 42 consecutive cases. Ann Chir Plast Esthet 2004;49:3-10.   DOI
13 Shpitzer T, Neligan PC, Gullane PJ, et al. The free iliac crest and fibula flaps in vascularized oromandibular reconstruction: comparison and long-term evaluation. Head Neck 1999;21:639-47.   DOI
14 Daniels TR, Thomas R, Bell TH, et al. Functional outcome of the foot and ankle after free fibular graft. Foot Ankle Int 2005;26:597-601.   DOI
15 Clark S, Greenwood M, Banks RJ, et al. Fracture of the radial donor site after composite free flap harvest: a ten-year review. Surgeon 2004;2:281-6.   DOI
16 Sinclair CF, Gleysteen JP, Zimmermann TM, et al. Assessment of donor site morbidity for free radial forearm osteocutaneous flaps. Microsurgery 2012;32:255-60.   DOI
17 Werle AH, Tsue TT, Toby EB, et al. Osteocutaneous radial forearm free flap: its use without significant donor site morbidity. Otolaryngol Head Neck Surg 2000;123:711-7.   DOI
18 Bardsley AF, Soutar DS, Elliot D, et al. Reducing morbidity in the radial forearm flap donor site. Plast Reconstr Surg 1990;86:287-92.   DOI
19 Deleyiannis FW, Sacks JM, McLean KM, et al. Patient self-report of disability of the upper extremity following osteocutaneous radial forearm free flap harvest. Plast Reconstr Surg 2008;122:1479-84.   DOI
20 Villaret DB, Futran NA. The indications and outcomes in the use of osteocutaneous radial forearm free flap. Head Neck 2003;25:475-81.   DOI
21 Shindo M, Fong BP, Funk GF, et al. The fibula osteocutaneous flap in head and neck reconstruction: a critical evaluation of donor site morbidity. Arch Otolaryngol Head Neck Surg 2000;126:1467-72.   DOI
22 Hidalgo DA. Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg 1989;84:71-9.   DOI
23 Ling XF, Peng X. What is the price to pay for a free fibula flap? A systematic review of donor-site morbidity following free fibula flap surgery. Plast Reconstr Surg 2012;129:657-74.   DOI
24 Zimmermann CE, Borner BI, Hasse A, et al. Donor site morbidity after microvascular fibula transfer. Clin Oral Investig 2001;5:214-9.   DOI
25 Toschka H, Feifel H, Erli HJ, et al. Aesthetic and functional results of harvesting radial forearm flap, especially with regard to hand function. Int J Oral Maxillofac Surg 2001;30: 42-8.   DOI
26 Thoma A, Khadaroo R, Grigenas O, et al. Oromandibular reconstruction with the radial-forearm osteocutaneous flap: experience with 60 consecutive cases. Plast Reconstr Surg 1999;104:368-78.   DOI
27 Zenn MR, Hidalgo DA, Cordeiro PG, et al. Current role of the radial forearm free flap in mandibular reconstruction. Plast Reconstr Surg 1997;99:1012-7.   DOI
28 Richardson D, Fisher SE, Vaughan ED, et al. Radial forearm flap donor-site complications and morbidity: a prospective study. Plast Reconstr Surg 1997;99:109-15.   DOI
29 Akashi M, Hashikawa K, Takasu H, et al. Comparison between primary closure and skin grafts of the free fibula osteocutaneous flap donor site. Oral Maxillofac Surg 2016;20: 233-7.   DOI
30 Momoh AO, Yu P, Skoracki RJ, et al. A prospective cohort study of fibula free flap donor-site morbidity in 157 consecutive patients. Plast Reconstr Surg 2011;128:714-20.   DOI
31 Yilmaz M, Vayvada H, Menderes A, et al. A comparison of vascularized fibular flap and iliac crest flap for mandibular reconstruction. J Craniofac Surg 2008;19:227-34.   DOI
32 Catala-Lehnen P, Rendenbach C, Heiland M, et al. Long-term donor-site morbidity after microsurgical fibular graft: is there a difference between the medial approach and the lateral approach? J Oral Maxillofac Surg 2012;70:2198-204.   DOI
33 Sieg P, Taner C, Hakim SG, et al. Long-term evaluation of donor site morbidity after free fibula transfer. Br J Oral Maxillofac Surg 2010;48:267-70.   DOI
34 Rogers SN, Lakshmiah SR, Narayan B, et al. A comparison of the long-term morbidity following deep circumflex iliac and fibula free flaps for reconstruction following head and neck cancer. Plast Reconstr Surg 2003;112:1517-25.   DOI
35 Tang CL, Mahoney JL, McKee MD, et al. Donor site morbidity following vascularized fibular grafting. Microsurgery 1998;18:383-6.   DOI
36 Ferri J, Piot B, Ruhin B, et al. Advantages and limitations of the fibula free flap in mandibular reconstruction. J Oral Maxillofac Surg 1997;55:440-8.   DOI
37 Sagalongos OS, Valerio IL, Hsieh CH, et al. Qualitative and quantitative analyses of donor-site morbidity following suprafascial versus subfascial free fibula flap harvesting. Plast Reconstr Surg 2011;128:137-45.   DOI
38 Ferrari S, Ferri A, Bianchi B, et al. Donor site morbidity after scapular tip free flaps in head-and-neck reconstruction. Microsurgery 2015;35:447-50.   DOI
39 Chim H, Salgado CJ, Mardini S, et al. Reconstruction of mandibular defects. Semin Plast Surg 2010;24:188-97.   DOI
40 Lee JH, Alrashdan MS, Kim SG, et al. Functional and esthetic assessment of radial forearm flap donor site repaired with split thickness skin graft. Eur Arch Otorhinolaryngol 2011;268:109-15.   DOI
41 Garg RK, Wieland AM, Poore SO, et al. The radial forearm snake flap: a novel approach to oral cavity and oropharyngeal reconstruction that reduces forearm donor site morbidity. Microsurgery 2017;37:6-11.   DOI
42 Sharma M, Balasubramanian D, Thankappan K, et al. Propeller flaps in the closure of free fibula flap donor site skin defects. Ann Plast Surg 2013;71:76-9.   DOI
43 Rendenbach C, Kohlmeier C, Suling A, et al. Prospective biomechanical analysis of donor-site morbidity after fibula free flap. J Craniomaxillofac Surg 2016;44:155-9.   DOI
44 Bach CA, Guillere L, Yildiz S, et al. Comparison of negative pressure wound therapy and conventional dressing methods for fibula free flap donor site management in patients with head and neck cancer. Head Neck 2016;38:696-9.   DOI
45 Mohindra A, Parmar S, Praveen P, et al. The fat-fascia paddle only with a composite fibula flap: marked reduction in donor site morbidity. Int J Oral Maxillofac Surg 2016;45:964-8.   DOI
46 Feuvrier D, Sagawa Y Jr, Beliard S, et al. Long-term donor-site morbidity after vascularized free fibula flap harvesting: clinical and gait analysis. J Plast Reconstr Aesthet Surg 2016; 69:262-9.   DOI
47 Li X, Zhu K, Liu F, et al. Assessment of quality of life in giant ameloblastoma adolescent patients who have had mandible defects reconstructed with a free fibula flap. World J Surg Oncol 2014;12:201.   DOI
48 Zavalishina L, Karra N, Zaid WS, et al. Quality of life assessment in patients after mandibular resection and free fibula flap reconstruction. J Oral Maxillofac Surg 2014;72:1616-26.   DOI
49 Ling XF, Peng X, Samman N. Donor-site morbidity of free fibula and DCIA flaps. J Oral Maxillofac Surg 2013;71:1604-12.   DOI
50 Mitsimponas KT, Iliopoulos C, Stockmann P, et al. The free scapular/parascapular flap as a reliable method of reconstruction in the head and neck region: a retrospective analysis of 130 reconstructions performed over a period of 5 years in a single department. J Craniomaxillofac Surg 2014; 42:536-43.   DOI
51 Bianchi B, Ferri A, Ferrari S, et al. Reconstruction of mandibular defects using the scapular tip free flap. Microsurgery 2015;35:101-6.   DOI
52 Lin CH, Wei FC, Levin LS, et al. Donor-site morbidity comparison between endoscopically assisted and traditional harvest of free latissimus dorsi muscle flap. Plast Reconstr Surg 1999;104:1070-7.   DOI
53 Clemens MW, Kronowitz S, Selber JC. Robotic-assisted latissimus dorsi harvest in delayed-immediate breast reconstruction. Semin Plast Surg 2014;28:20-5.   DOI
54 Dowthwaite SA, Theurer J, Belzile M, et al. Comparison of fibular and scapular osseous free flaps for oromandibular reconstruction: a patient-centered approach to flap selection. JAMA Otolaryngol Head Neck Surg 2013;139:285-92.   DOI
55 Kalavrezos N, Hardee PS, Hutchison IL. Reconstruction of through-and-through osteocutaneous defects of the mouth and face with subscapular system flaps. Ann R Coll Surg Engl 2005;87:45-52.
56 Clark JR, Vesely M, Gilbert R. Scapular angle osteomyogenous flap in postmaxillectomy reconstruction: defect, reconstruction, shoulder function, and harvest technique. Head Neck 2008;30:10-20.   DOI
57 Forrest C, Boyd B, Manktelow R, et al. The free vascularised iliac crest tissue transfer: donor site complications associated with eighty-two cases. Br J Plast Surg 1992;45:89-93.   DOI
58 Piazza C, Paderno A, Taglietti V, et al. Evolution of complex palatomaxillary reconstructions: the scapular angle osteomuscular free flap. Curr Opin Otolaryngol Head Neck Surg 2013;21:95-103.   DOI