Assessment of fibula flap with flexor hallucis longus's effect on head & neck tumor patients' quality of life and function of donor site

• Published in: Oral oncology Vol. 100; no. C; p. 104489
• Main Authors: Ni, Youkang, Zhang, Xuedi, Zhang, Zhiqiang, Liang, Weidi, Zhao, Lina, Li, Zijia, Li, Siqi, Lu, Ping, Xu, Zhongfei, Dai, Wei, Duan, Weiyi, Tan, Xuexin, Sun, Changfu, Liu, Fayu
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.01.2020; Elsevier
• Subjects: Donor site morbidity; Fibula free flap; Flexor hallucis longus; Muscle strength; Quality of life; Donor site morbidity; Fibula free flap; Muscle strength; Flexor hallucis longus; Quality of life
• ISSN: 1368-8375; 1879-0593
• DOI: 10.1016/j.oraloncology.2019.104489

•Whether fibula flap with or without FHL, it makes no significant difference.•The fibula flap with FHL saves the flap harvesting time.•Surgeons can use two flap without considering more FHL’s effects on patients. Free fibular flaps (FFFs) have been widely used in mandibular reconstruction. It is still unclear whether retaining flexor hallucis longus (FHL) is needed for flaps. This study introduces a comparison in quality of life and donor-site function between those who have and haven't harvested FHL with FFF. Patients with FFFs were single-blind-randomly assigned into the FHL group or nFHL group. Patients were followed up preoperatively and 1, 3 and 6 months postoperatively via subjective evaluations (SF-36/AOFAS) and objective evaluation s(muscle strength and range of motion). Patients' hospitalization and intraoperative information, donor site morbidity were recorded. Each group had 15 patients. The flap harvesting time in FHL group was shorter significantly than nFHL group (125.9 ± 24.8 min vs 146.7 ± 29.9 min, P = 0.048). There were no significant differences in hospitalization information such as operation time, hospitalization days and cost. Donor site morbidities at 1, 3 and 6 months postoperatively showed no significant differences except for the presence of claw toes (nFHL group > FHL group, 40% vs 0, P = 0.017; 53.3% vs 6.7%, P = 0.014; 60.0% vs 13.3%, P = 0.021). There were no significant differences in SF-36 and AOFAS scores. There were no significant differences in muscle strength and range of motion. Excision of the FHL lowered the flap harvesting time. It did not increase donor site morbidity. The impacts on patients' quality of life and foot function were the same. The surgeons can use the FHL without considering the influence on patients if not retaining the FHL.