Donor Site Morbidity In Patients Research Articles

Quantifying donor site morbidity in anterior cruciate ligament reconstruction using peroneus longus tendon autograft

Objectives: The objective of this study was to assess the donor site morbidity in patients having anterior cruciate ligament reconstruction (ACLR) using peroneus longus tendon (PLT) autograft. Methods: A prospective cohort study was conducted at the orthopedic department of Pakistan Atomic Energy Commission General Hospital, Islamabad, from July 2021 to July 2023. A total of 150 patients aged between 20 and 40 years with an anterior cruciate ligament injury requiring ligament reconstruction were included in the study. Exclusion criteria included previous ankle ligamentous injuries, fractures or surgeries around the ankle, and high-risk sports like football. After the ACLR surgery, the patients were assessed for pain, range of motion (ROM), and muscle power in the 6th week, 3rd month, and 6th month. Return to jogging without discomfort at the ankle during 1st min of jogging was assessed at six months. Results: Of the 150 patients, 142 (94.6%) were male and 8 (5.4%) were female. The mean age of participants was 32.53 ± 4.78 years. Pain and loss of ROM around the ankle were reduced after six months compared to three months and six weeks, that is, P < 0.05. Muscle power was increased after six months (n = 152; 94.0%) (P < 0.001). In the 6th month, 133 patients (88.7%) were able to jog without discomfort around the ankle joint during the 1st min of jogging, but 17 patients (11.3%) started jogging after six months without discomfort at the ankle joint during the 1st min of jogging (P < 0.001). Conclusion: ACLR using the PLT autograft resulted in a good functional outcome, smooth rehabilitation with an early return to sports, and minimal complications at the donor site.

Quality of life and subjective donor-site morbidity in patients after a free fibula flap

INTRODUCTIONWe evaluated the subjective donor-site morbidity and quality of life in patients with a free fibula flap (FFF) reconstruction in terms of self-reported symptoms, function and quality of life, and we compared inclusion vs. exclusion of the flexor hallucis longus (FHL) muscle in the graft, primary wound closure vs. skin graft and the occurrence vs. absence of donor-site complications. METHODSIn this cross-sectional study, patients who underwent a mandibula or maxilla reconstruction with a FFF between 2011-2021, were included. Symptoms and function were measured with the Foot and Ankle Outcome Score (FAOS) and quality of life with both FAOS and a Visual Analogue Scale (VAS). RESULTS34 patients were included in the analyses (mean age 59 years, 59% males). Most patients underwent a mandibular reconstruction for a malignancy. The median FAOS domain scores ranged between 92.9 (IQR 77.7-100.0) and 100.0 (IQR 88.2-100.0) points, and the median VAS score was 86.5 points. No statistically significant differences were found between inclusion vs. exclusion of the FHL, primary wound closure vs. graft and occurrence vs. absence of donor-site complications. An unfavorable trend was seen for inclusion of the FHL in the flap on recreational functioning, and quality of life. CONCLUSIONPatients who underwent a free fibula flap experience little donor-site morbidity and high quality of life, as measured by FAOS and VAS.

Donor-site Morbidity following Microvascular Fibular Transfer for Head and Neck Reconstruction

BACKGROUND: Continuous refinement in head and neck reconstruction requires a thorough evaluation of donor-site morbidity of established workhorse flaps. Regardless of the favoritism bestowed on the free fibular flap (FFF) for head and neck reconstruction by most microsurgeons, the donor-site morbidity associated with harvesting remains a controversial and concerning issue. In fact, the perioperative donor-site complication rate following FFF harvest ranges between 2% to 38%. The objective of this study is to analyze surgical and postoperative factors that contribute to donor-site morbidity in patients undergoing FFF transfer for mandibular and/or maxillary reconstruction of oncologic defects. METHODS: We conducted a prospective single-institutional investigation to analyze complications and assess their effect on the postoperative status of the ankle, great toe, and gait in 53 patients who underwent reconstruction of maxillary and/or mandibular defects with the FFF. We used the American Academy of Orthopaedic Surgeons foot and ankle questionnaire (AAOS-FAOQ), X-ray of ankles, and clinical examination (pain, paresthesia, claw toe deformity, and range of motion) to evaluate postoperative outcomes one, three, and six months after surgery. RESULTS: Forty-six males (86.8%) and seven females (13.2%) were finally included. The mean age was 50.18 years (range, 22-75). The mean tourniquet time was 74.25 minutes. The mean length of the segment of fibula harvested was 12.85 ± 1.1 cm, while the residual mean distal and proximal fibula segment length were 6.6 cm (range, 6-8) and 6.7 cm (range, 6-8) respectively. The mean size of the skin paddle harvested was 53.2 cm2 (range, 36-64 cm2). Flap failure secondary to venous congestion was seen in 2 cases. The most common acute donor site complications recorded were edema of the ipsilateral foot (11.30%) and delayed wound healing (9.4%). Additional complications reported included partial graft loss (7.5%) and wound infection (7.5%). Three of the four grafts that were partially lost, had signs of infection (75%). Spontaneous recovery was observed in the 3 partial graft loss cases (75%) whereas 1 patient (25%) required an additional STSG. Long-term claw toe deformity was observed in 1 patient (1.8%) who had required excision of the flexus hallucis longus. Nerve alterations were present in the form of paresthesia (39.6%) and superficial peroneal nerve sensory loss (18.9%). The overall rate of perioperative donor site complications was 35.8%. Significant improvement in the average AAOS-FAOQ score was observed at 6-months when compared to 1-month results (p<.001). Dorsiflexion (p=0.923) and plantarflexion (p=0.913) did not significantly improve at different time points. Complications did not affect range of motion for dorsiflexion (p=0.759) or plantarflexion (p=0.254) at 6-months. A larger residual fibular stump (≥8cm) did not significantly affect postoperative ROM for dorsiflexion (p=0.232) or plantarflexion at 6-months. A large skin paddle area resulted in an increase in incidence of complications. (p <.001). CONCLUSION: Although FFF is associated with a high complication rate and postoperative reduction in lower limb performance, these findings do not challenge the reliability of this versatile flap. A larger flap’s skin paddle increases the rate of donor-site complications. Future studies focusing on refinement of harvest technique are anticipated.

Donor Site Morbidity in Patients Undergoing Maxillofacial Reconstruction Using Free Fibula Flap Versus Deep Circumflex Artery Flap-A Systematic Review.

A systematic review of the literature on the donor site morbidity in patients undergoing Maxillofacial reconstruction was performed. The two widely used flaps namely free fibula flap (FFF) and DCIA flap were compared to answer the following questions: (1) Is donor site morbidity significantly different in patients undergoing maxillofacial reconstruction with FFF and DCIA flap? (2) Should donor site morbidity be considered as the criteria for choosing the flap for reconstruction. The search strategy was based on PRISMA guidelines. Various electronic databases were searched. On reviewing the seven articles included in our systematic review, we found out oral squamous cell carcinoma to be the most common pathology leading to the defects in head and neck region requiring reconstruction with free flaps. A total of 531 participants were investigated who underwent maxillofacial reconstruction using FFF and DCIA flap. The study included both the genders. The participants were assessed for short- and long-term donor site morbidity after the microvascular surgery. Mean age is 45-60 years. Three out of seven studies showed DCIA to have lesser complications at donor site than fibula group. While other two studies proved FFF to be better than DCIA. One study proved low donor site morbidity with regard to both the flap. The free fibula being the flap of choice in head and neck reconstruction has a comparable donor site morbidity to DCIA. The advantages of the iliac artery flap include natural curvature, abundant vertical and horizontal bone height for bone contouring and osseointegration, hidden scar, low incidence of wound healing problems and minimal effect on function and quality of life at long-term follow-up. Thus, it makes it the free flap of choice that one cannot avoid. This systematic review was registered at PROSPERO (CRD42021268949).

Cartilage Graft Donor Site Morbidity following Rhinoplasty and Nasal Reconstruction.

Although surgical techniques for rhinoplasty and nasal reconstruction are well established, prospective research on postoperative morbidity remains limited. The aim of this pilot study was to assess costal and auricular cartilage donor site pain and morbidity in patients undergoing rhinoplasty and nasal reconstruction. In this prospective cohort study, we enrolled 55 patients undergoing nasal surgery that required costal or auricular cartilage harvest from February 2015 through May 2016. Each patient was given a symptom-specific patient survey that assessed general pain, nasal pain, graft donor site pain, graft donor site itching, color variation, skin stiffness and thickness, and graft donor site appearance at 1, 4, and 12 weeks after surgery. Our patient group was 55% female ( n = 30); the mean age was 47 years. Rib cartilage graft patients had significantly greater nasal pain than cartilage donor site pain. There was no significant difference in rib versus ear cartilage donor site pain. Nearly all patients reported that they were not at all concerned about their scar appearance or ear shape and appearance. No prior studies compare cartilage donor site morbidity in patients undergoing nasal surgery. Our findings challenge the conventional wisdom that utilizing auricular and costal cartilage results in high levels of donor site pain. Surgeons should have a low threshold to harvest rib or ear cartilage when it can improve surgical outcome.

A Novel Application of Double-Paddle Peroneal Chimeric Flap as External Sentinel Monitor in Hypopharyngeal Reconstruction

Monitoring the viability of buried free flaps in hypopharyngeal reconstruction is difficult. Various methods have been proposed to monitor these buried flaps, but limitations remain. We present a method of using double-paddle chimeric peroneal flaps that permanently externalizes a flap skin paddle as a monitoring paddle in hypopharyngeal reconstructions. This study was performed in a medical center in southern Taiwan; between 2013 and 2015, 10 patients underwent double-paddle chimeric peroneal flap reconstruction in advanced stages of hypopharyngeal cancer. We retrospectively reviewed the medical records from these surgeries, searching for either short-term postoperative complications or long-term follow-up morbidity and researched relevant articles for comparisons with other monitoring methods. None of the 10 flaps underwent total loss. The rate of stenosis and that of fistula formation was 10%. The average postoperative hospital stay was 39 days. Six of 10 patients were able to resume at least a soft diet after reconstruction, and none of the patients experienced significant complications. The peroneal flap is a useful flap because it is thin and pliable, has minimal donor site morbidity in patients without peripheral vascular disease, and has the potential of multiple skin paddles so that one skin paddle can be used for monitoring the buried flap. Using this method, direct clinical monitoring is feasible, and early detection of vascular complications is possible. Furthermore, the drawbacks of using a monitoring paddle produced by a deepithelialized bridge can be avoided.

Video‐Assisted ALT Harvesting, Technique Validation, and Results

Objective: We have previously described a novel video-assisted technique (VAT) for the identification of cutaneous perforators of the anterolateral thigh (ALT) free flap. We sought to validate the technique by comparing its findings with standard open thigh exploration in a series of consecutive patients. Method: Retrospective review of a prospectively collected database; 23 consecutive cases operated at a tertiary academic institution between September 2010 and October 2011. In all these cases a standard open exploration of the thigh—considered the gold standard—was performed immediately after the endoscopic exploration. Data retrieved included surgical findings, demographics, and outcomes. Results: There were 16 males and 7 females with a mean age of 55 (23-83). The most common defect location was cutaneous n = 7 (30.4%) and oral cavity in n = 6 (26.1%). Average operative time for VAT was 25.4 minutes (9-47). On standard exploration there were 53 total perforators identified; 49 of these were successfully identified endoscopically. Findings were discordant in 4 cases (17.4%), with the endoscopic technique missing 1 perforator in all of 4 of them. The sensitivity of VAT was 92.4% (CI, 80.9-97.5) with a correlation coefficient of 0.91 with open exploration. All flaps survived, and there were no complications associated with the technique. Conclusion: Video-assisted exploration has a high sensitivity for identification of cutaneous perforators of the thigh. There is a high correlation between findings with this technique and a standard open approach. This minimally invasive technique could help minimize donor site morbidity in patients undergoing reconstruction with an ALT free flap.

Donor site morbidity in oral mucosa graft urethroplasty: implications of tobacco consumption

BackgroundThe purpose of this prospective study was to evaluate the donor site morbidity in patients who have undergone oral mucosa graft urethroplasty for stricture of the urethra. The impact of smoking and oral consumption of tobacco and/or paan masala on the donor site was also assessed. This study is probably the first of its kind where the affect of smoking, paan masala and tobacco chewing on the donor site morbidity has been documented.MethodsForty-eight patients suffering from stricture of the urethra underwent oral mucosa graft urethroplasty between July 2005 and December 2007. The patients were divided into two groups (users or non-users) based on tobacco consumption and oral hygiene. The donor site was evaluated at frequent intervals for pain, swelling, numbness, bleeding, salivation and tightness of mouth.ResultsDonor site morbidity was more in users with poor oral hygiene. Pain scores were higher amongst the users and the morbidity persisted longer in the users compared to non-users with good oral hygiene.ConclusionPatients who consume tobacco and have poor oral hygiene should be warned regarding poorer outcomes after oral mucosa graft urethroplasty.

Avoiding Secondary Skin Graft Donor Site Morbidity in the Fibula Free Flap Harvest

To compare donor site morbidity in patients who have undergone fibula free flap reconstruction in which the skin graft was taken from the expected cutaneous paddle of the fibula with the known complications of the popular technique of obtaining a split-thickness skin graft (STSG) from a secondary donor site. Cohort study. The tertiary care centers at Loma Linda University Medical Center and University of California, Los Angeles, Medical Center. From September 1, 2006, to March 30, 2007, 30 patients underwent fibula free flap harvest by 2 surgeons at separate tertiary care centers. Twenty-one of those procedures took place at the University of California, Los Angeles, and 9 at Loma Linda University. Patients included 15 men (50%) and 15 women (50%), with a mean age of 58 (range, 19-88) years. All 30 patients underwent fibula free flap harvest with a split-thickness skin graft (graft thickness, 0.04 cm), obtained from osteocutaneous paddle using a 5.1-cm-wide dermatome, as well as oral cavity and oropharyngeal reconstruction with the de-epithelialized skin paddle. Measures of donor site morbidity, including graft failure and wound breakdown, and measures of recipient site morbidity, including flap failure, hardware complications, intraoral complications, and the need for additional surgery. Of the 30 patients who underwent this procedure, 4 had partial skin graft failures, for a complete skin graft survival of 87%. There were no complete skin graft losses. Regarding the fibula osteocutaneous free flap, there were no complete flap losses, 1 skin paddle necrosis that required debridement, 2 postoperative orocutaneous fistulas, 1 case of infected/extruded hardware, and 1 adhesion formation that required additional surgery for lysis of adhesion and placement of the split-thickness skin graft. The outlined novel technique has similar rates of free flap survival and skin graft take compared with previously described methods. Harvesting the skin graft over the expected osteocutaneous paddle results in decreased lower extremity morbidity by providing equivalent graft tissue for donor site closure and eliminating the morbidity of a secondary donor site. As long as there will not be 2 large opposing grafted surfaces, this technique should be considered when harvesting fibula free flaps for reconstruction of oromandibular resection defects, especially in cancers of the alveolar ridge and floor of the mouth.

Donor-Site Morbidity after Free Ileocolon Flap Transfer for Esophageal and Voice Reconstruction

Radical excision of advanced hypopharyngeal and laryngeal tumors usually compromises both swallowing and speech. Among the available reconstruction methods, the free ileocolon flap allows rehabilitation of both functions in one stage. The donor-site morbidity of this flap has not been addressed in head and neck cancer patients. A retrospective study was conducted in 34 patients between April of 2003 and December of 2007 to investigate donor-site morbidity in patients undergoing reconstruction with free ileocolon flaps. Complications such as diarrhea, upper gastrointestinal tract distress, bowel leak, abscess, or hernia formation were evaluated. Significant association of diarrhea and upper gastrointestinal distress, previous abdominal operations, systemic diseases, primary versus secondary reconstruction, flap length, and postoperative chemotherapy were subsequently evaluated. Differences were considered significant for values of p <or= 0.05. There were no perioperative or postoperative deaths. Nineteen patients (56 percent) experienced temporary diarrhea. In all but two patients, diarrhea discontinued by 4 months. Chemotherapy was significantly associated with diarrhea (p < 0.01). Colchicine, terbinafine, and heroin withdrawal episodically caused diarrhea but statistical conclusions could not be drawn. Six patients (18 percent) suffered from upper gastrointestinal tract problems (gastroduodenal ulcer, erosive gastritis, and minor bleeding), probably because of insufficient gastric protection. The free ileocolon flap proved to be a reliable method when simultaneous restoration of swallowing and speech was required, with donor-site morbidity comparable to that of the other intestinal flaps.

Microvascular Free Tissue Transfer for Tongue Reconstruction After Hemiglossectomy: A Functional Assessment of Radial Forearm Versus Anterolateral Thigh Flap

The purpose of this study was to evaluate tongue function and donor site morbidity in patients with oral cancer surgically treated and reconstructed with radial or anterolateral thigh free flaps. Twenty patients underwent primary reconstruction after hemiglossectomy between January 2002 and June 2004. Ten patients were reconstructed using a free forearm flap and the remaining with an anterolateral thigh flap. Eight patients on each group underwent postoperative radiotherapy (average, 60 Gy). All of them were followed postoperatively to determine after 6 months their functional outcome as it related to speech, deglutition, tongue mobility, and donor site morbidity. The intelligibility, deglutition, and tongue mobility were each scored on a scale ranging from 1 to 7 by an independent investigator. Data were analyzed by the 2-tail Mann-Whitney U test. No differences in mean speech intelligibility, tongue mobility, or deglutition mean scores were seen between radial forearm flap and anterolateral thigh flap (P > .05). In all anterolateral thigh flap-treated cases, the donor site was closed directly and no complications were seen. However, in all forearm flaps donor site closure was carried out with skin grafts and dorsal forearm splinting was applied for 1 week postoperatively. In 4 cases a partial skin graft failure was observed and donor sites healed for second intention. Anterolateral thigh flap, with its versatility in design, long pedicle with a suitable vessel diameter, and low donor site morbidity, could be the ideal flap for hemiglossectomy defect reconstruction.

Sural Nerve Donor-Site Morbidity

This study presents a long-term evaluation of sural nerve donor-site morbidity in patients with at least 15 years' follow-up (mean 26 years) after sural nerve harvesting for peripheral nerve repair. Twenty-nine patients (mean age 30 years at time of surgery) participated in a retrospective analysis using a questionnaire. The subjective patient evaluations indicated a significant recovery of the sural nerve donor site with regard to sensory loss, pain, and cold sensitivity over time. Beyond 5 years, no further improvement is to be expected. Our findings provide a guideline for general patient information regarding sural nerve donor-site morbidity. An area of sensory loss of approximately the size of 5 x 6 cm is to be expected, and 20%-30% of the patients experienced minimal levels of pain, cold sensitivity, functional impairment, and scar discomfort. The latter 2 were confined to inconvenience with bumping of the donor site and putting on shoes.

Rectus femoris muscle flap donor-site morbidity

Donor-site morbidity in four patients after reconstruction with free neurovascular rectus femoris muscle was examined through a series of strength tests in which the leg with rectus femoris muscle harvested was compared with the contralateral leg with an intact rectus femoris muscle. The tests were conducted with three testing devices: (1) the 'Con-Trex Leg-press' in which the force and power of right and left leg extensions at 0.2 and 0.4 m/s in a knee angle from 50 to 90 degrees were tested separately; (2) the isometric power tester, which enabled the unilateral evaluation of the isometric leg extension at three knee angles: 50, 70 and 90 degrees ; and (3) at the 'SP-Force Platforms' in which the patients performed a counter-movement jump where the amplitude of the ground reaction force, the parameters maximum force, and the jump height were calculated in order to compare the right and left leg during a single dynamic movement. Our results showed that the patients (with one exception) demonstrated a balanced relationship between the donor leg and the intact contralateral leg. The patient that primarily demonstrated a large strength deficit was retested 3 months later and showed, after an extensive rehabilitation and training program, an impressive increase in strength. The authors concluded that there is no significant limitation in the strength of the donor leg after removal of the rectus femoris muscle and consequently no significant functional donor-site morbidity. We believe that for the realisation of such results that the intraoperative linking of the vastus lateralis muscle with the vastus medialis muscle, especially in their lower third, and an extensive postoperative rehabilitation and training program are essential.

Anterior cervical discectomy for one- and two-level cervical disc disease: the controversy surrounding the question of whether to fuse, plate, or both.

Since the introduction of anterior approaches to the cervical spine for the surgical treatment of degenerative disc disease, controversies have developed regarding the necessity of fusion following anterior cervical discectomy, the use of allografts instead of autologous bone for fusion, and, recently, the employment of anterior cervical plating systems in addition to fusion for uncomplicated disc disease. We reviewed seven clinical papers dealing with these issues; these articles surveyed a total of 1153 patients. Several observations can be made from these reviews. First, there is little or no difference in clinical outcome following single-level anterior discectomy, whether a fusion is performed or not, regardless of whether the operation was for soft discs or osteophytes. Second, most patients who underwent two-level discectomies had outcomes comparable to patients who underwent surgery at one level, regardless of whether they were fused or not. Data from four prospective randomized clinical studies in addition to multiple non-randomized or retrospective studies support these conclusions. Although the incidence of complications such as persistent postoperative posterior cervical and shoulder pain and kyphotic deformities is higher in unfused patients (and is quite significant in some series), the advantages conferred by interbody fusion such as biomechanical stability, decreased incidence of kyphotic deformity, and decreased pain are offset by graft and donor-site morbidity. Specific indications for fusion include multi-level discectomies, significant straightening of the cervical spine, failed prior fusions, and trauma. It has been demonstrated that comparable fusion rates can be achieved with allografts rather than harvested autologous bone. The advantages of autografts over allografts are relatively slight in most patients who undergo anterior fusion for one- or two-level disc disease, although patients with impaired healing, significant osteopenia, or concomitant microvascular disease, such as chronic smokers, may benefit from autologous bone. The use of allografts avoids donor-site morbidity in patients without these problems. Anterior cervical plates are useful for cases of instability requiring fusion (such as trauma); these implants may decrease reoperation rates and the incidence of delayed instability in select cases. However, the cost-effectiveness of their generalized use for uncomplicated cervical disc disease has not been demonstrated. In conclusion, a general statement regarding the optimal surgical treatment for cervical disc herniations using anterior approaches is difficult to make with this limited review. Surgeons' experience and familiarity with a particular approach are probably the most important factors in ensuring successful outcomes.