Effect of Fibula Free Flap Harvest on the Gait of Head and Neck Cancer Patients: Preliminary Results

Objective: To determine the impact of fibula free flaps (FFFs) on gait. Design: Prospective trial. Setting: FFF patients who gave consent were enrolled. Methods: At preoperative and 3-month postoperative visits, patients walked 30 m with the Walkabout Portable Gait Monitor (WPGM), a portable device developed at Dalhousie University that records acceleration of the centre of mass. Gaitview software provided several outputs for analysis: vertical (VA) and forward (FA) asymmetry, horizontal to vertical power ratio (HVP), vertical to forward power ratio (VFP), velocity, and step length. Patients were compared pre- and postoperatively and to age-matched control data with a Student paired t-test. Patients completed a self-comorbidity questionnaire and a point evaluation system (PES) with subjective questions on gait. PES data were compared to a Mann-Whitney U test using SPSS, version 15.0.1. Main Outcome Measures: Gaitview output and PES questionnaire. Results: From September 2008 to January 2010, 12 patients enrolled in the study. Eight provided 3-month postoperative data. The Gaitview analysis showed that none of the six parameters changed postoperatively. The VA and FA preoperatively and at 3 months postoperatively were 21.3 versus 24.2, p > .50, and 65.4 versus 74.9, p > .50, respectively. The HVP and VFP preoperatively and postoperatively were 133.4 versus 138.9, p > .50, and 129.6 versus 122.8, p > .50, respectively. The velocity and step length preoperatively and postoperatively were 125.9 versus 119.5 cm/s, p > .50, and 76.0 versus 74.9 cm, p > .50, respectively. The subjective PES questionnaire did not change significantly (p = .26). Conclusion: Preliminary findings confirm that the FFF is associated with little subjective or objective gait impairment.