Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: Early mobilization after head and neck free flap surgery has been associated with a lower risk of major complications and shorter post-operative length of stay. Historically an argument against early mobilization for fibula free flap (FFF) patients has been the concern for donor site complications. Here we describe our experience with early postoperative mobilization in FFF patients.
Methods: For this case series we reviewed the records of patients who underwent FFF surgery at our institution between September 2016 and August 2024 and extracted data focused on their postoperative physical therapy and wound healing. At our institution, all free flap patients are ordered for physical therapy postoperative day one (POD1) with no weight bearing restrictions. FFF patients wear a controlled ankle movement boot when out of bed for four weeks. We performed a literature review to obtain benchmarks for donor site complication rates and previously reported postoperative mobilization protocols.
Results: Eighty fibula free flap surgeries were performed on 76 patients. One patient with baseline quadriplegia was excluded. Average length of stay was 10 days (range: 5-27, median: 8). In 65 (82.3%) cases, patients mobilized with physical therapy on POD1. Of these, 54 (92.3%) were weight-bearing, with five (7.7%) immediately ambulating. Patients’ first day of ambulation was on average POD3 (range: POD1 to POD9, median: POD3). In 42 (53.1%) cases, patients were negotiating stairs with varying degrees of assistance at time of discharge. Sixty-nine (86.1%) cases were discharged home, five (6.3%) to acute rehabilitation, and five (6.3%) to subacute rehabilitation. In 61 cases (77.2%) skin grafts were used to reconstruct the donor site, 43 (70.5%) full thickness and 18 (29.5%) split thickness. Of these, partial graft loss occurred in six (9.3%) and total graft loss in one (1.6%). Tendon exposure occurred in two cases overall (2.5%).
Conclusion: Early mobilization following fibula free flap surgery does not appear to confer inordinate morbidity on the donor site and should be considered in light of the increasingly demonstrated benefit to these patients in the postoperative period.