{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T01:09:33Z","timestamp":1760231373225,"version":"build-2065373602"},"reference-count":36,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,9,9]],"date-time":"2022-09-09T00:00:00Z","timestamp":1662681600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Symmetry"],"abstract":"<jats:p>The autologous vascularised free fibula flap is currently considered the best option for facial reconstruction after oncological surgery, but its donor-site morbidity has not been fully examined. The purpose was to evaluate donor-site changes in temporal and spatial kinematic gait parameters during stair climbing, as well as the gait symmetry. Fourteen patients (48 \u00b1 16 years) were evaluated before and six months after harvest of a vascularised free fibula flap. Temporal gait variables for both the ascent and descent phases did not change after surgery (2-way ANOVA, p &gt; 0.05). During stair ascent, ankle flexion (healthy side, increased; donor side, reduced; low effect size) had a significant time \u00d7 side interaction. During stair descent, hip flexion was significantly larger on the donor side (medium effect size). Significant time \u00d7 side interactions were observed for ankle inversion (healthy side, reduced; donor side, increased; and low effect size) and knee flexion (healthy side, increased; donor side, unchanged; and low effect size). Medium effect sizes were found for hip flexion side differences (significant). No relevant spatio-temporal nor kinematic asymmetry emerged apart from ankle joint kinematics. Overall, only the side effect of hip flexion during descent was both statistically significant and practically meaningful. Considering the slight modifications of the gait variables, no major functional limitations were found following vascularised free fibula flap reconstruction during stair climbing and descent.<\/jats:p>","DOI":"10.3390\/sym14091888","type":"journal-article","created":{"date-parts":[[2022,9,13]],"date-time":"2022-09-13T22:37:28Z","timestamp":1663108648000},"page":"1888","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Donor-Site Morbidity after Osteocutaneous Free Fibula Transfer: Longitudinal Analysis of Stair Climbing Asymmetry and Functional Outcome"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0649-3665","authenticated-orcid":false,"given":"Matteo","family":"Zago","sequence":"first","affiliation":[{"name":"Dipartimento di Scienze Biomediche per la Salute, Universit\u00e0 degli Studi di Milano, I-20133 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8435-8672","authenticated-orcid":false,"given":"Riccardo","family":"Di Giuli","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Biomediche per la Salute, Universit\u00e0 degli Studi di Milano, I-20133 Milano, Italy"},{"name":"Department of Biomedical, Surgical and Dental Sciences, Universit\u00e0 degli Studi di Milano, I-20133 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giada","family":"Beltramini","sequence":"additional","affiliation":[{"name":"Department of Biomedical, Surgical and Dental Sciences, Universit\u00e0 degli Studi di Milano, I-20133 Milano, Italy"},{"name":"Maxillofacial and Dental Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico di Milano, I-20122 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Bolzoni","sequence":"additional","affiliation":[{"name":"Department of Biomedical, Surgical and Dental Sciences, Universit\u00e0 degli Studi di Milano, I-20133 Milano, Italy"},{"name":"Maxillofacial and Dental Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico di Milano, I-20122 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Baj","sequence":"additional","affiliation":[{"name":"Department of Biomedical, Surgical and Dental Sciences, Universit\u00e0 degli Studi di Milano, I-20133 Milano, Italy"},{"name":"Maxillofacial and Dental Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico di Milano, I-20122 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2772-4837","authenticated-orcid":false,"given":"Manuela","family":"Galli","sequence":"additional","affiliation":[{"name":"Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, I-20133 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5983-9674","authenticated-orcid":false,"given":"Aldo Bruno","family":"Giann\u00ec","sequence":"additional","affiliation":[{"name":"Department of Biomedical, Surgical and Dental Sciences, Universit\u00e0 degli Studi di Milano, I-20133 Milano, Italy"},{"name":"Maxillofacial and Dental Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico di Milano, I-20122 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6532-6464","authenticated-orcid":false,"given":"Chiarella","family":"Sforza","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Biomediche per la Salute, Universit\u00e0 degli Studi di Milano, I-20133 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.coms.2014.01.001","article-title":"Epidemiologic trends in head and neck cancer and aids in diagnosis","volume":"26","author":"Vigneswaran","year":"2014","journal-title":"Oral Maxillofac. Surg. Clin. N. Am."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Boscolo-Rizzo, P., Zorzi, M., Del Mistro, A., Da Mosto, M.C., Tirelli, G., Buzzoni, C., Rugge, M., Polesel, J., and Guzzinati, S. (2018). The evolution of the epidemiological landscape of head and neck cancer in Italy: Is there evidence for an increase in the incidence of potentially HPV-related carcinomas?. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0192621"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1002\/ijc.30107","article-title":"Trends in oral cavity cancer incidence, mortality, survival and treatment in the Netherlands","volume":"139","author":"Brands","year":"2016","journal-title":"Int. J. Cancer"},{"key":"ref_4","unstructured":"Goyal, N., Hennessy, M., Lehman, E., Lin, W., Agudo, A., Ahrens, W., Boccia, S., Brennan, P., Brenner, H., and Cadoni, G. (2022). Risk factors for head and neck cancer in more and less developed countries: Analysis from the INHANCE consortium. Oral Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.18203\/2394-6040.ijcmph20220032","article-title":"Epidemiology and types of oral cancer","volume":"9","author":"Batwa","year":"2022","journal-title":"Int. J. Community Med. Public Health"},{"key":"ref_6","first-page":"185","article-title":"Gait changes in patients after reconstruction of facial bones with fibula and iliac crest free vascularized flaps","volume":"20","author":"Syczewska","year":"2018","journal-title":"Acta Bioeng. Biomech."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/j.jcms.2019.01.037","article-title":"The use of vascularized fibula flap in mandibular reconstruction; A comprehensive systematic review and meta-analysis of the observational studies","volume":"47","author":"Awad","year":"2019","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.joms.2014.07.043","article-title":"Stair ascent and descent in assessing donor-site morbidity following osteocutaneous free fibula transfer: A preliminary study","volume":"73","author":"Baj","year":"2015","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"371","DOI":"10.14639\/0392-100X-504","article-title":"Valutazione tridimensionale dei movimenti mandibolari dopo ricostruzione con lembo libero di fibula","volume":"35","author":"Bolzoni","year":"2015","journal-title":"Acta Otorhinolaryngol. Ital."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1016\/j.joms.2018.10.016","article-title":"Donor-Site Morbidity After Osteocutaneous Free Fibula Transfer: Longitudinal Analysis of Gait Performance","volume":"77","author":"Zago","year":"2019","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/j.bjps.2015.10.007","article-title":"Long-term donor-site morbidity after vascularized free fibula flap harvesting: Clinical and gait analysis","volume":"69","author":"Feuvrier","year":"2016","journal-title":"J. Plast. Reconstr. Aesthetic Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"495","DOI":"10.5999\/aps.2017.01592","article-title":"Osteocutaneous flaps for head and neck reconstruction: A focused evaluation of donor site morbidity and patient reported outcome measures in different reconstruction options","volume":"45","author":"Kearns","year":"2018","journal-title":"Arch. Plast. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1604","DOI":"10.1016\/j.joms.2013.03.006","article-title":"Donor-site morbidity of free fibula and DCIA flaps","volume":"71","author":"Ling","year":"2013","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1097\/PRS.0b013e318221dc2a","article-title":"A prospective cohort study of fibula free flap donor-site morbidity in 157 consecutive patients","volume":"128","author":"Momoh","year":"2011","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1001\/archotol.126.12.1467","article-title":"The fibula osteocutaneous flap in head and neck reconstruction: A critical evaluation of donor site morbidity","volume":"126","author":"Shindo","year":"2000","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1007\/s00784-001-0140-5","article-title":"Donor site morbidity after microvascular fibula transfer","volume":"5","author":"Zimmermann","year":"2001","journal-title":"Clin. Oral Investig."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1097\/PRS.0b013e3182402d9a","article-title":"What is the price to pay for a free fibula flap? A systematic review of donor-site morbidity following free fibula flap surgery","volume":"129","author":"Ling","year":"2012","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1007e","DOI":"10.1097\/PRS.0000000000008588","article-title":"Patient-reported outcomes after fibula free flap harvest: A pilot study","volume":"148","author":"Hatchell","year":"2021","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e119","DOI":"10.1016\/j.rehab.2016.07.269","article-title":"Donor-site morbidity after vascularized free flap fibula: Gait analysis during prolonged walk condition","volume":"59","author":"Hadouiri","year":"2016","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1097\/MOO.0000000000000286","article-title":"Minimizing free flap donor-site morbidity","volume":"24","author":"Harris","year":"2016","journal-title":"Curr. Opin. Otolaryngol. Head Neck Surg."},{"key":"ref_21","first-page":"77","article-title":"Y-Balance Test But Not Functional Movement Screen Scores Are Associated With Peak Knee Valgus Moments During Unplanned Sidestepping: Implications For Assessing Anterior Cruciate Ligament Injury Risk","volume":"35","author":"Lee","year":"2017","journal-title":"Int. Soc. Biomech. Sport."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.bjoms.2016.11.007","article-title":"Star excursion balance test for assessment of dynamic instability of the ankle in patients after harvest of a fibular free flap: A two-centre study","volume":"55","author":"Shah","year":"2017","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Attia, S., Diefenbach, J., Schmermund, D., B\u00f6ttger, S., Pons-K\u00fchnemann, J., Scheibelhut, C., Heiss, C., and Howaldt, H.P. (2020). Donor-site morbidity after fibula transplantation in head and neck tumor patients: A split-leg retrospective study with focus on leg stability and quality of life. Cancers, 12.","DOI":"10.3390\/cancers12082217"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.jcms.2015.10.027","article-title":"Prospective biomechanical analysis of donor-site morbidity after fibula free flap","volume":"44","author":"Rendenbach","year":"2016","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/j.ijom.2008.04.005","article-title":"Gait analysis of donor leg after free fibular flap transfer","volume":"37","author":"Lee","year":"2008","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_26","first-page":"S34","article-title":"Effect of fibula free flap harvest on the gait of head and neck cancer patients: Preliminary results","volume":"40","author":"Macdonald","year":"2011","journal-title":"J. Otolaryngol. Head Neck Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.clinbiomech.2014.11.004","article-title":"Bilateral symmetry in lower extremity mechanics during stair ascent and descent following a total hip arthroplasty: A one-year longitudinal study","volume":"30","author":"Queen","year":"2015","journal-title":"Clin. Biomech."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"474e","DOI":"10.1097\/PRS.0b013e31827c73f6","article-title":"Minimally invasive harvest of free fibula flap","volume":"131","author":"Baj","year":"2013","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1016\/j.gaitpost.2007.08.006","article-title":"The symmetry angle: A novel, robust method of quantifying asymmetry","volume":"27","author":"Avrin","year":"2008","journal-title":"Gait Posture"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.edurev.2010.12.001","article-title":"Eta squared and partial eta squared as measures of effect size in educational research","volume":"6","author":"Richardson","year":"2011","journal-title":"Educ. Res. Rev."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1037\/0033-2909.112.1.155","article-title":"A power primer","volume":"112","author":"Cohen","year":"1992","journal-title":"Psychol. Bull."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1016\/S0268-0033(03)00179-7","article-title":"Frontal and sagittal plane analyses of the stair climbing task in healthy adults aged over 40 years: What are the challenges compared to level walking?","volume":"18","author":"Nadeau","year":"2003","journal-title":"Clin. Biomech."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"104614","DOI":"10.1016\/j.oraloncology.2020.104614","article-title":"Sex disparities in head & neck cancer driver genes: An analysis of the TCGA dataset","volume":"104","author":"Mundi","year":"2020","journal-title":"Oral Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1007\/s12663-020-01337-8","article-title":"Assessment of Donor Site Morbidity Following Fibula Flap Transfer","volume":"20","author":"Maben","year":"2021","journal-title":"J. Maxillofac. Oral Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1016\/j.ijom.2007.04.013","article-title":"Clinical outcome and patient satisfaction after mandibular reconstruction with free fibula flaps","volume":"36","author":"Kesting","year":"2007","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.jcms.2016.11.014","article-title":"Donor site morbidity and quality of life after microvascular head and neck reconstruction with free fibula and deep-circumflex iliac artery flaps","volume":"45","author":"Schardt","year":"2017","journal-title":"J. Cranio-Maxillofac. Surg."}],"container-title":["Symmetry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2073-8994\/14\/9\/1888\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:28:11Z","timestamp":1760142491000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2073-8994\/14\/9\/1888"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,9]]},"references-count":36,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9]]}},"alternative-id":["sym14091888"],"URL":"https:\/\/doi.org\/10.3390\/sym14091888","relation":{},"ISSN":["2073-8994"],"issn-type":[{"type":"electronic","value":"2073-8994"}],"subject":[],"published":{"date-parts":[[2022,9,9]]}}}