Donor leg morbidity after Vascularised Free Fibula Flap: Is there a difference between patients reported outcomes and dynamic ankle stability as assessed by Star Excursion Balance Test

J.P. Peehal, K. Shah, S. Crank, M. Cope

Aim: To look at the morbidity in the donor leg with vascularised free fibular Flap (VFFF) by using patient reported outcome measures, clinical examination and dynamic ankle stability assessment by using Star Excursion Balance Test (SEBT).

Method: Series of 13 consecutive cases of VFFF done at Hull Royal Infirmary between Aug 2009 and Aug 2012. For subjective assessment American Orthopaedic Foot and Ankle Society Score (AOFASS), Foot and Ankle Disability Index (FADI), Visual analog pain (VAP) score (0 to 10) and feeling of instability were recorded. Clinical assessment included recording range of movements (ROM), drawer test, clawing of toes, abnormal gait, muscle weakness, any loss of sensation in leg-ankle-foot and SEBT was used for assessment of dynamic ankle stability.

Results: Mean age of patients was 57 years, mean follow up period was 14 months. Three patients had superficial infection, five patients had persistent pain (mean VAP score was 3.5), three patients had reduced ROM and four patients reported feeling of instability in the ankle joint, but did not have instability on assessment. Mean AOFASS was 85 and mean FADI was 84. There was very good correlation between AOFASS and FADI (= 0.95). There was no significant differences between the corresponding reach distances by operated and non-operated legs during SEBT. Six patients had sensory loss (all had loss in the superficial peroneal nerve distribution area and 3 in addition also had in the sural nerve distribution area)

Conclusion: This study demonstrates over all very good patient reported outcomes following VFFF and this corresponds with SEBT finding that the dynamic ankle stability of the donor leg is not affected as compared to opposite non-operated leg. Some morbidity like pain, loss of sensation or restriction of movement of ankle joint can occur as a price for the procedure.