The free fibula flap and its variations are now widely used in various clinical applications for microvascular reconstructions. Occasionally and to add bulk the flexor hallucis longus (FHL) muscle is harvested along with the fibula. Additionally, the postoperative morbidity is usually described as mild and temporary, however, the reduction of the flexion of the hallucis is expected when muscle is harvested. This is a retrospective study that assess 32 patients. Patients included in the study are from 1995-2009 and form a cohort of 167 patients. All 167 had mandibular reconstruction with the fibula free flap, 64 were deceased, 29 lost to follow-up, 14 did not meet the inclusion criteria and 28 did not wish to participate in the study. All patients were assessed by a blinded observer, taken as an average of three attempts measuring the range of motion (ROM) of the metatarsophalangeal joint and interphalangeal joint and the combined strength of the Hallux flexors. Donor legs had significant decrease in strength of the Hallux flexion. They conclude free fibula flap donor site morbidity is independent of intentional harvest of the FHL muscle. A good reason for this is the anatomy for the FHL. The proximal attachment of the muscle is lower two thirds of the posterior surface of the fibula and the adjacent posterior septum. The blood supply to the muscle is totally via the peroneal artery and motor innervations via the muscle branch of the tibial nerve. Following the harvest of the fibula and its peroneal vessels the muscle (GFHL) is possibly left devascularised and denervated. While the final outcome regarding the morbidity is small overall, it is relevant there is no effect in preserving the FHL.

The effect of flexor hallucis longus harvest on hallux function: a retrospective cross-sectional cohort study.
Heuvel SCM, Veen FJC, Winters HAH.
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Sunil K Bhatia

Royal Shrewsbury Hospital, Shrewsbury, UK.

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