Morbidity of Early and Late Donor-Site Complications After Free Fibular Flap for Head and Neck Reconstruction: A Systematic Review

Free fibular flap has been widely used for head and neck reconstruction. However, studies on donor-site complications after free fibular flap are lacking. This study aims to systematically review the morbidity of early and late donor-site complications following FFF transplantation for head and neck reconstruction. A systematic search was conducted in PubMed, EMBASE, Cochrane Library, Web of Science, and MEDLINE databases until April 2023. Weighted means was calculated to pool the morbidity of complications. Finally, 34 studies were included. The weighted mean morbidity of common early donor-site complications was wound dehiscence (8%), necrosis (4%), delayed healing (27%), infection (6%), total skin graft loss (1%), and partial loss (11%). Late donor-site complications included chronic pain (14%), limited range of ankle motion (16%), ankle instability (6%), reduced muscle strength (24%), toe weakness (24%), claw toe (19%), gait abnormality (19%), sensory deficit (26%), numbness (28%) and limitations in walking (19%), running (31%), and upstairs (20%). High morbidity of early and late donor-site complications following FFF surgery was observed. Thorough preoperative assessment and flap design are crucial to minimize complications risk. Further studies are warranted to investigate other potential influencing factors and provide more specific treatment suggestions.