Abstract
BACKGROUND: This study aimed to compare donor-site morbidity among three common major lower extremity free flaps: fibula (FFF), anterolateral thigh (ALT), and the medial sural perforator (MSAP) using an established patient-reported outcome measure (PROM), the Lower Extremity Functional Scale (LEFS).
METHODS: Patients who underwent head and neck reconstruction with either FFF, MSAP, or ALT were included. The primary outcome was functional recovery, assessed using the modified LEFS, a PROM measuring functional status, administered at multiple post-operative timepoints.
RESULTS: Seventy-five patients were included in the analysis: 33 FFF, 22 MSAP and 20 ALT. Patients undergoing lower extremity free flap surgery overall recovered well. The LEFS scores at different time points demonstrated quicker recovery for the MSAP group, while ALT and FFF recovered later. After 360 days, the MSAP group also demonstrated improved functional outcomes compared to the ALT and FFF.
CONCLUSION: Patients undergoing lower extremity free flap surgery recover well. The MSAP had the least donor-site morbidity. Donor-site morbidity should be considered when counseling patients.