Purpose:
The standard fibula osteocutaneous flap often requires skin grafting for donor site coverage due to the limited skin redundancy in the lower third of the fibula. In contrast, our previously published algorithm suggests alternative flap designs that may enable primary closure of the donor site. This study aims to compare the outcomes of donor sites closed either by primary closure or by skin grafting.

Material and method:
We conducted a retrospective study of patients diagnosed with head and neck cancer who underwent fibula flap reconstruction at E-DA Hospital between June 2018 and June 2023. Variables analyzed included the method of donor site closure, dimensions of the skin paddle (length and width), complications at the donor site, time to resumption of walking, duration of hospital stay, and antibiotic use.

Result:
Of the 40 patients studied, 21 achieved primary donor site closure with a 95.2% success rate. The remaining 19 required skin grafts, with a few experiencing complications like infection or needing secondary operations. No significant differences were found in skin paddle dimensions between the two groups. Patients with primary closures had shorter hospital stays, used fewer intravenous antibiotics, and resumed walking faster (p-values <0.05). Early donor site morbidity showed no significant difference between groups (p=0.31).

Conclusion:
Compared to traditional skin grafting methods, primary closure led to benefits such as shorter hospital stays, reduced intravenous antibiotic use, and quicker resumption of walking. While skin paddle dimensions varied, they did not significantly affect the method of donor site closure. These findings suggest that primary closure could be a preferred alternative to skin grafting for donor site management, although no significant differences were found in early donor site morbidity. Future studies with larger sample sizes are needed to validate these results and explore long-term outcomes.

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