Patient-Reported Outcomes after Fibula Free Flap Harvest: A Pilot Study.

SUMMARY: Patient-reported outcomes regarding donor-site morbidity and quality of life for the fibula free flap in head and neck reconstruction patients have not been studied. The authors reviewed and identified patients who had undergone head and neck reconstruction using a fibula free flap (2011 to 2016). Patients were assessed via physical examination and two patient-reported outcomes questionnaires: the Foot and Ankle Outcome Score (score range, 0 to 100) and the Pain Disability Questionnaire (score range, 0 to 100). Quantitative data were analyzed with appropriate statistical tests. Semistructured interviews exploring donor-site challenges were performed and analyzed using thematic analysis. Seventeen patients agreed to participate. Their mean age was 62 years (range, 41 to 81 years). Mean follow-up was 38 months (range, 12 to 65 years). Mean perceived level of function compared to baseline was 67 percent. Mean scores for the Foot and Ankle Outcome Score subscales were 84.6 (pain), 80.5 (symptoms), 86.7 (activities of daily living), 67.7 (sport), and 65.6 (quality of life). The mean Pain Disability Questionnaire score was 26.3 (mild/moderate perceived disability). Higher perceived level of function was associated with higher Foot and Ankle Outcome Score values (pain, symptoms, and activities of daily living, p < 0.05). Donor limbs had decreased range of motion and manual muscle testing scores compared with their contralateral limbs (p < 0.05). Lack of ankle support and balance, resulting in limitations and aversions to daily and sporting activities, were the most common themes regarding donor-site challenges. In conclusion, patients who have undergone fibula free flap harvest struggle with ankle support and balance and face functional difficulties that have an impact on their quality of life. Multidisciplinary approaches for targeted rehabilitation after fibula free flap harvest should be explored to determine the impact on patients' quality of life.

Evaluating CNVII Recovery after Reconstruction with Vascularized Nerve Grafts: A Retrospective Case Series.

Few studies have evaluated vascularized nerve grafts (VNGs) for facial nerve (CNVII) reconstruction. We sought to evaluate long-term outcomes for CNVII recovery following reconstruction with VNGs. A retrospective review of all patients at a tertiary centre who underwent radical parotidectomy and immediate CNVII reconstruction with VNGs was performed (January 2009-December 2019). Preoperative demographics, perioperative factors (flap type, source of VNGs), and postoperative factors [complications, adjuvant therapy, revisionary procedures, length of follow-up, and CNVII function via the House-Brackmann scale (HB)] were collected. Data were summarized qualitatively. Twelve patients (Mage = 53 ± 18 years) with a mean follow-up of 33 (± 23) months were included. Six patients underwent reconstruction with a radial forearm flap and dorsal sensory branches of the radial nerve. Six patients underwent reconstruction with an anterolateral thigh flap and only deep motor branches of the femoral nerve to the vastus lateralis (n = 4) or combined with the lateral femoral cutaneous nerve (n = 2). Two patients regained nearly normal function (HB = 2). Eight patients regained at least resting symmetry (HB = 3 for n = 7; HB = 4 for n = 1). One patient regained a flicker of movement (HB = 5). One patient did not regain function (HB = 6). Six patients had static revision procedures to improve symmetry. Five patients had disease recurrence; 3 died from their disease. VNGs offer a practical and viable addition to the CNVII reconstruction strategy, and result in good functional recovery with acceptable donor site deficits. The associated adipofascial component of these flaps can also augment the soft tissue defect left after tumor ablation.

Novel Plate Design to Improve Mandibular and Maxillary Reconstruction with the Osteocutaneous Fibula Flap.

Virtual surgical planning (VSP) has improved the accuracy and efficiency of craniofacial reconstruction using the osteocutaneous free fibula flap. Despite this, challenges remain in translating the VSP to a real-world construct due to small changes that can occur after osteotomies of the mandible or maxilla. Poor execution of the VSP can lead to malocclusion, undesirable aesthetics, or poor bony contact at the sites of osteosynthesis. We describe a novel technique using Selective LASER Melted plates to achieve maximum control and accuracy of complex, virtually planned reconstructions of the mandible and maxilla.

Incidence and Type of Errors in Microsurgical Technique in Surgical Trainees.

Background The purpose of our study was first to identify microsurgical errors and their incidence. Identifying these common errors and the theoretical approach to prevent or repair them may provide benefit to trainees in the laboratory setting and, ultimately, in the clinical setting. Methods Using a rat femoral artery anastomoses model for resident microsurgical training, direct staff observation with real-time feedback and error identification was employed. Types of microsurgical errors were recorded and instructor feedback relayed to five resident participants. Results Errors were cataloged into five main categories: insufficient approximation (26.1%), vessel backwall (21.7%), incomplete bites (19.6%), tissue tear (19.6%), and irregular widths (13.0%). Further subdivision of the incomplete bite error based on vessel layer violated was performed. Representative figures were created outlining these errors. Conclusions We present common microsurgical errors in trainees and a training model with synchronous feedback. Visual images were designed outlining these errors as an adjunct for teaching.