Comparison of the Functional and Esthetic Outcomes of Free Parascapular and Anterolateral Thigh Flaps for Ankle Reconstruction

Objective: Microvascular tissue transfer, which is one of the last steps of the reconstruction ladder is often the preferred method in lower extremity distal 1/3 defects since the soft-tissue reserve is limited and the musculoskeletal system and neurovascular structures that are effective in ensuring the functional continuity of this region are superficial. There are no studies in the literature comparing the functional results of the free parascapular flap and the anterolateral thigh (ALT) flap in ankle reconstruction; therefore, we aimed to evaluate the functional results of these two different free flaps in the reconstruction of the ankle. Methods: A retrospective study was undertaken of all patients who presented with soft-tissue ankle defects treated with either ALT or parascapular flap between October 2010 and January 2022. Patients demographic data, lower-extremity functional scale, satisfaction survey score, and Vancouver scar scale were recorded for both groups. The cross tables and Chi-square statistics were used to check the relationships; independent t-tests were used for comparisons between the two groups; and one-way ANOVA statistics were used for multigroup comparisons. Results: In this study, 62 patients received free ALT flaps, and 58 patients underwent par-ascapular flap reconstruction. The function of the ankle was reported to be significantly better in patients who had a parascapular flap. Furthermore, when flap thicknesses were compared, it was found that the parascapular flap was significantly thinner than the ALT flap. The relationship between the donor artery and vein diameter and flap complications was statistically significant; there were significantly fewer complications in flaps with a vessel diameter over 3.2 mm. Conclusion: The surgeon’s experience, donor site morbidity, and the esthetic results of the flap often come to the fore in the selection of flaps in microsurgery. Although the ALT flap has become popular in recent years, the free parascapular flap can be preferred over the ALT flap because it provides better functional results and more advantages for ankle soft-tissue reconstruction. ABSTRACT