ORIGINAL RESEARCH article
Front. Oncol.
Sec. Head and Neck Cancer
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1651547
This article is part of the Research TopicMultidisciplinary Management of Oral Cancer: Diagnosis, Treatment, and RehabilitationView all 13 articles
Functional Outcomes and Quality of Life Following Free Fibula Flap Harvest: A Comparative Analysis of Flexor Hallucis Longus Resection Versus Preservation
Provisionally accepted
- 1Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital,Capital Medical University, Beijing, China
- 2Zhumadian Central Hospital, Zhumadian, China
- 3Henan Cancer Hospital Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
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Background: The free fibula flap (FFF) is a gold standard for maxillofacial reconstruction, yet debate persists regarding the functional impact of flexor hallucis longus (FHL) resection. This study evaluates donor-site morbidity and quality of life (QoL) following FFF reconstruction, comparing outcomes with and without FHL resection. Methods: A retrospective analysis of prospectively collected data was conducted for 93 patients undergoing FFF reconstruction. Patients were stratified into FHL-harvested and non-FHL groups. Primary outcomes included QoL, AOFAS scores, hallux flexion strength, range of motion (ROM), isokinetic dynamometry, and gait analysis. Assessments were performed preoperatively and at 3- and 6-month intervals. Results: The study cohort comprised 93 patients, with FHL harvested in 43 cases. The FHL group exhibited transient declines in QoL at 3 months, with partial recovery by 6 months. Both groups showed similar AOFAS score trajectories, with temporary declines at 3 months and near-complete recovery by 6 months. Hallux flexion strength decreased comparably in both groups at 3 months (FHL: −38%; non-FHL: −34%), with residual 18–20% deficits at 6 months. Isokinetic testing revealed transient plantar flexion weakness in the FHL group at higher velocities (90°/s: 54.2±7.0 Nm vs. 58.6±7.5 Nm pre-op, p=0.008), resolving by 6 months. Gait analysis demonstrated initial impairments in stride length and ankle ROM in the FHL group, normalizing by 6 months. Conclusion: FHL resection during FFF harvest leads to transient functional and QoL impairments, but most deficits resolve within 6 months. Preservation is advisable when feasible, though FHL harvest remains safe for cases requiring additional soft tissue.
Keywords: Free fibula flap, Quality of Life, Flexor hallucis longus, Donor site morbidity, Objective assessment
Received: 22 Jun 2025; Accepted: 30 Jul 2025.
Copyright: © 2025 Fang, Zhao, Zhang, Du and Yuan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Qigen Fang, Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital,Capital Medical University, Beijing, China
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