Donor-site morbidity after vascularized free flap fibula: Gait analysis during prolonged walk condition.

OBJECTIVE: Fibula and leg muscles play an important role during gait. The vascularized free fibula flap (VFFF) harvesting procedure could have an impact during short walking distance [1]. However, little is know about the VFFF effect during prolonged walk conditions [2]. The aim of this study was to determine the effect after VFFF harvesting on the evolution of spatiotemporal gait parameters during a 6-Minutes Walk Test (6MWT) and to compare results with those found in healthy persons.

MATERIAL/PATIENTS AND METHODS: Eleven patients post VFFF and 11 healthy matched controls were included. The evaluations included the collection of clinical data, measuring 6MWT, recording the gait spatiotemporal parameters and angle gait (°) through a GAITRite system. These gait parameters were evaluated during three intervals of the 6MWT: T1 [0-1'], T2 [2:30-3:30'] and T3 [5,6'].

RESULTS: The distance of the 6MWT of the VFFF group was significantly smaller (31%) than those found for the control group (median: LLFV, 436 meters vs. control, 632 meters). Most of the spatiotemporal gait parameters were significantly different between group for each interval (P=[0.04-10(-4)]), especially between the angle of gait for the operated side and those found for the control group (P=0.007). Regarding comparisons among the intervals, velocity has decreased between T1 and T2 and has increased between T2 and T3 for each group. However, the T3 velocity was significantly lower than the T1 velocity only for the VFFF group.

DISCUSSION-CONCLUSION: A velocity rebound effect was found during comparisons between the intervals, which was lesser for the VFFF group than those found for the control group. This could be explained by an alteration of the physical management strategy. The permanent angle gait increased of the operated side suggest a functional modification caused by the flexor hallucis muscle harvesting, which could disrupt agonists-antagonists muscles balance in the frontal plane. This modification could alter the gait and joint integrity in the long term. The VFFF harvesting could decrease patients' autonomy. The earliest rehabilitation program could limit this harvest injuries.