FUNCTIONAL OUTCOME OF THE FOOT AND ANKLE FOLLOWING FREE FIBULAR GRAFT

Abstract

This study demonstrates that harvesting a vascularized fibular graft has a significant number of minor complications. These complications do not result in significant morbidity but could be avoided by other newer methods of managing bony defects and avascular necrosis such as porous bone substitute rods.

The purpose of this study was to evaluate functional outcomes of the foot and ankle following vascularized fibula graft harvest, using validated outcome measures.

This study agrees with previous reports in that minor complications are commonly associated with free fibula harvest. Functional outcome scores demonstrate significant differences in pain and disability; however, the disability associated with daily activities is small.

This is the first study to assess the outcomes of vascularized fibular grafts with validated outcomes measures. It is one of a few studies to assess the outcomes of vascularized fibular grafts on an otherwise normal lower extremity.

Twenty-two patients were available for study, with ten attending for examination. All had undergone free fibula transfer for mandibular reconstruction. Functional outcome was assessed using MODEMS (includes SF-36) and Foot Function Index (FFI). A radiographic analysis was performed. All patients had a normal contralateral foot and ankle which was used as a control. Mean follow-up is 3.1 years.

Sixty percent of patients were satisfied following surgery. Subjective complaints of weakness, instability and numbness were reported. Minor wound complications were seen in twenty-three percent of patients and clawing of the lesser toes in eighteen percent. No significant difference was seen in the SF-36 categories when compared to population norms. The FFI identified significant differences in Pain and Disability means when compared to the contralateral side. Radiographic analysis failed to demonstrate increased arthritic change or instability. Two patients had undergone further surgery for toe clawing and persistent ankle pain.