Qualitative and quantitative analyses of donor-site morbidity following suprafascial versus subfascial free fibula flap harvesting

Background: The free fibular flap has become the workhorse flap for composite mandibular defect reconstruction. As advancements in microsurgery have improved flap survival, greater interest has shifted toward flap refinements to avert donor-site morbidities. Methods: A total of 27 free fibular flaps used for mandible reconstruction were studied prospectively. Of the 27 flaps, 18 suprafascial and nine subfascial dissections were performed. A questionnaire was developed and completed by all patients to assess qualitative aspects of donor-site morbidity and function. Quantitative studies focused on bilateral isokinetic testing of each patients lower extremities by comparing and quantifying the ankle function. Results: For the subfascial group, 42 percent of patients complained of pain and alteration in sensation. These donor-site morbidities within the suprafascial group were negligible. Using the Wilcoxon rank sum test, scores obtained from the questionnaires were analyzed, with significant differences seen in wound problems/cosmetic appearance between the two groups (p = 0.0114). For the subfascial group, the donor leg showed significantly less range of motion in plantar-flexion exercises (p = 0.03). Comparing the isokinetic examination results of the suprafascial and subfascial groups, a significant decrease in ankle dorsiflexion, plantar flexion, and foot eversion was evident in the subfascial group. Conclusions: The qualitative or subjective perception of donor-site morbidity, for the suprafascial method of fibular flap harvest, is relatively low. Quantitative analysis revealed that this method did not cause decreases in ankle function, and it had superior contour and aesthetic outcomes compared with the conventional, subfascial method.