Morbidity of donor and recipient sites after free flap surgery. A prospective study

Abstract

Although free flap transfer is a routine procedure, we know of few studies about post-operative morbidity at recipient and donor sites. The strength of the shoulder extension after harvesting of a latissimus dorsi free flap (n = 12) and the patients' subjective opinions of morbidity at recipient and donor sites (n = 23) were assessed two and six weeks, and three,six, and nine months after transfer of free muscle flaps. The patients' subjective opinions were measured on a scale from 1 (normal) to 5 (very troublesome) and the strength of the shoulder was measured in N. The flaps used were latissimus dorsi (n = 18), rectus abdominis (n = 4), and gracilis (n = 1). All but one were transplanted to a lower extremity. The extension strength of the shoulder decreased from 105 N to 70 N immediately after the operation (p < 0.05), and strength did not improve during follow up. Subjectively assessed morbidity at the recipient site and cosmetic disability decreased from troublesome or very troublesome to moderate (p < 0.05). Swelling decreased from moderate at two weeks to normal or slight at nine months (p < 0.05). The subjective morbidity at the donor site decreased from slight at two weeks to normal at nine months for functional disability (p < 0.05). Cosmetic disability at the donor site was minimal during follow up. This study shows that shoulder extension strength deteriorated permanently after part of the latissimus dorsi muscle had been removed even though subjective morbidity was minimal. Morbidity at the recipient site decreased significantly with time. Subjective opinion of morbidity after latissimus dorsi transplantation did not differ from that after rectus abdominis transplantation.