{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T11:23:44Z","timestamp":1783164224471,"version":"3.54.6"},"reference-count":21,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T00:00:00Z","timestamp":1772668800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T00:00:00Z","timestamp":1772668800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head & Neck"],"published-print":{"date-parts":[[2026,8]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n The flexor hallucis longus (FHL) is often manipulated during free fibula flap (FFF) harvest. While its resection facilitates exposure, the impact on long\u2010term donor\u2010limb function remains unclear.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This prospective cohort study compared 12\u2010month functional outcomes between patients undergoing FFF harvest with intentional FHL preservation (\n n<\/jats:italic>\n \u2009=\u200946) and those requiring FHL resection (\n n<\/jats:italic>\n \u2009=\u200933). A standardized rehabilitation protocol was implemented. Outcomes were assessed via patient\u2010reported measures (AOFAS\u2010AH, FFI), objective clinical tests (manual muscle testing, single\u2010leg heel rise, 6\u2010min walk, single\u2010leg stance), and instrumented 3D gait analysis at preoperative, 3\u2010, 6\u2010, and 12\u2010month timepoints.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The FHL\u2010harvested group demonstrated significant early deficits in great toe strength, gait propulsion (peak plantarflexion moment and power), walking endurance, balance, and patient\u2010reported function compared to the FHL\u2010preserved group (all\n p<\/jats:italic>\n \u2009<\u20090.05 at 3\u2009months). However, by 12\u2009months postoperatively, all measured functional parameters, including kinetic gait metrics and patient\u2010reported scores, recovered to levels statistically indistinguishable from the FHL\u2010preserved group (all\n p<\/jats:italic>\n \u2009>\u20090.05). Donor\u2010site complication rates were equivalent between groups (6.5% vs. 6.1%,\n p<\/jats:italic>\n \u2009=\u20091.000).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n While FHL resection during FFF harvest is associated with significant transient functional impairment, structured rehabilitation facilitates substantial neuromuscular adaptation. By 12\u2009months, patients achieve functional recovery comparable to those with an intact FHL, suggesting that FHL harvest is a viable option with manageable functional morbidity when surgically necessary for optimal flap dissection.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/hed.70214","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T17:23:38Z","timestamp":1772990618000},"page":"2019-2029","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Flexor Hallucis Longus Preservation vs. Harvest in Fibula Free Flap Surgery: Functional Recovery and Gait Outcomes at 12\u2009Months"],"prefix":"10.1002","volume":"48","author":[{"given":"Jiebo","family":"Shan","sequence":"first","affiliation":[{"name":"Affiliated Hospital of Shaoxing University Zhejiang Province People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haiyan","family":"Wang","sequence":"additional","affiliation":[{"name":"Affiliated Hospital of Shaoxing University Zhejiang Province People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yicheng","family":"Shen","sequence":"additional","affiliation":[{"name":"Affiliated Hospital of Shaoxing University Zhejiang Province People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,5]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cxom.2023.04.005"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2024.1371405"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0b013e3181a2c772"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.27719"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.70047"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2023.04.048"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/10711007241226620"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12663-022-01698-2"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2024.01.038"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.27254"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2015.10.007"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijom.2017.10.006"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiomech.2024.106259"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2025.1651547"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2024.03.003"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2019.104489"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpra.2025.08.005"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.70031"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0044-1786989"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2025.01.021"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010025\u201018438\u20108"}],"container-title":["Head 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