Donor site complications are not usually of major significance. A potentially devastating exception is compromised vascularity of the donor site when the anatomical variation of an absent posterior tibial artery is not detected preoperatively. The limb is dependent on the peroneal blood supply and harvesting of the graft might lead to loss of the limb, if the anterior tibial artery has a deficiency.
Transient weakness of the peroneal muscles and sensory abnormalities on the lateral aspect of the leg may be observed, as well as flexion contracture of the hallux, secondary to scarring of the FHL, which may require surgical release. Peroneal nerve injury, compartment syndrome and tibial fracture have been rarely reported.
Careful dissection, meticulous hemostasis and avoidance of suturing the fascia will minimize these already infrequent events. Retaining 6 cm of the distal fibula will prevent adverse effects on the distal tibiofibular syndesmosis and the ankle joint. The weight bearing capacity of the tibia is adequate and will compensate for loss of the fibula, which normally supports only a sixth of the transferred loads.
In skeletally immature patients harvesting of the fibula could lead to valgus deformity of the ankle joint, therefore tibio-fibular stabilization is recommended.
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