Fibula Free Flap

Surgery 

Post - Operation

Possible Problems

Walking Post-Op

Hospital Stay

Dr. Kang will remove one of the two bones from the lower part of your leg (the fibula).  The fibula bone runs on the outside of the leg from the knee joint to the ankle joint.  It is a small, thin bone and can be entirely removed without affecting your ability to bear weight in the majority of patients.  The fibular bone is removed (the flap) along with two blood vessels, one of which supplies new blood to the flap (the artery) and one of which drains old blood away from the flap (the vein). Once the bone is removed, it is transferred to the head and neck area and secured into position with plates and screws.  The blood vessels supplying and draining the flap are then joined to blood vessels in your neck under a microscope.  These bloods vessels keep the flap alive while it heals into its new place.  Depending on the defect being reconstructed, the surgeon will often include an area of skin and/or muscle attached to the fibula.

Your leg will be placed in a bandage for a week following surgery.  A special boot will be worn most of the time to help maintain correct ankle position and to assist in walking.  The boot should be worn for approximately 1 month after surgery whenever you leave home, although you may try wearing supportive shoes while at home.  It often takes several weeks for the swelling in your feet to resolve enough before you can wear your normal shoe size.  You may also try wearing a shoe with the laces loose to accommodate your swollen foot.

Occasionally, it is necessary to remove a piece of skin along with the fibula bone.  If the piece of skin that is removed is large, it will need to be replaced with a skin graft from the upper outer thigh area.

The area of your leg where the bone has been removed is likely to be sore.  Regular pain medicine will be arranged for you.  A small tube may also be placed through the skin into the underlying wound to drain any blood the may collect.  This “drain” is usually removed after a few days while you are still in the hospital.

All incisions made though the skin leave a scar but the majority of these fade with time.  The scar on the outside of your leg runs from just below the knee joint to just above the ankle joint.  If a skin graft is necessary, you will also have a “patch” of skin from your upper thigh healing on the fibula surgical site above the ankle.

There are potential complications with any operation; most of them are rare.  However, it is important that you are aware of them and have the opportunity to discuss them with your surgeon.

• Bleeding:  since a “drain” is inserted into the wound, excess bleeding is unusual.
• Infection – you will be given antibiotics during surgery and for several days after surgery.  As a result, infection is usually not a problem.  Previous radiation therapy or uncontrolled diabetes may raise your risk of infection.
• Numbness:  sometimes you may notice a small patch of skin on the lower part or your leg or foot that is numb or tingly after the operation.  This numbness may take several months to disappear and in the minority of patients may be permanent.
• Flap failure:  in 5% of cases, one of the blood vessels supplying or draining the flap can develop a blood clot within it.  This means that the flap does not get any fresh blood or, if the drainage vein clots, then the flap becomes very congested with old blood.  It is an occurrence that usually happens with the first two days and means that you will have to return to the operating room to have the clot removed.  Removing the clot is not always successful and on these occasions the flap “fails” and an alternative method of reconstruction is sought.  In general, about 50% of flaps which are returned to the operating room are eventually saved.

In the long term, removing the fibular bone should produce minimal to no problems in your walking.  You will be on bed rest for a day or two after surgery.  Soon after this, you should be sitting up in a chair.  With the help of a physical therapist, you will start to walk around the 3rd day.  By the end of the second week, you should be walking near normally and climbing stairs.  Occasionally, you may need help (a cane or walker) for a further week or so.  You will have a padded boot for extra support.  We recommend using the boot for 1 month after surgery any time you leave home.

The minimum stay for this operation is usually 5-10 days, although other circumstances may require you to stay longer.  5-10 days is needed to allow some healing of the leg and to give the physical therapist time to get you walking on it again.