Safety of fibula free flap in patients following total knee replacement

Head Neck. 2021 Feb;43(2):585-589. doi: 10.1002/hed.26519. Epub 2020 Oct 21.


Background: Fibula free flap (FFF) is the preferred osteocutaneous flap for reconstruction of large head and neck composite defects. There is a paucity of data whether FFF can be performed safely in patients with knee replacement (total knee arthroplasty [TKA]).

Methods: Multi-institutional review of outcomes following FFF in patients who had prior TKA.

Results: Ten surgeons reported successful FFF in 53 patients with prior TKA. The most common preoperative imaging was a CT angiogram of the bilateral lower extremities. There was no evidence of intraoperative vascular abnormality. Physical therapy began between postoperative day 1 to postoperative day 3. At 1 month postoperatively, 40% of patients were using a cane or walker to ambulate, but by 3 months all had returned to baseline ambulatory status. At >1 year, there were no gait complications.

Conclusion: FFF appears safe in patients with prior knee replacement without an increased risk of complications compared to baseline.

Keywords: fibula free flap; fibula reconstruction; microvascular reconstruction; safety; total knee replacement.

Publication types

  • Multicenter Study

MeSH terms

  • Arthroplasty, Replacement, Knee*
  • Fibula / surgery
  • Free Tissue Flaps*
  • Humans
  • Plastic Surgery Procedures*
  • Postoperative Complications / epidemiology
  • Retrospective Studies