“Patient-reported aesthetic outcomes following lower extremity free flap reconstruction: a cross-sectional multicenter study”

Introduction The goal of lower extremity reconstructions is primarily to salvage the leg however aesthetic outcomes are also important. This study is aimed to assess the impact of a lower extremity free tissue transfer regarding, social functioning, patient-reported aesthetic outcomes, and possible differences between fasciocutaneous vs. muscle flaps. Material and Methods For this cross-sectional multicenter study, patients operated between 2003 and 2021, with a minimum follow-up of twelve months, were identified. Outcomes were obtained from 89 patients. Patient-reported outcomes were assessed using a questionnaire containing 5-point Likert scale questions grouped in three groups: aspect of the reconstructed leg, the aspect of the donor site, and the negative impact on social functioning. Physical functioning and mental health were assessed with the Short-Form-36 (SF36). Results The overall score for negative impact on social functioning was 22.2. This was 46.7 for the aesthetic satisfaction of the reconstructed leg and 57.1 for the donor site. No significant differences were seen in between patients who underwent a reconstruction with a fasciocutaneous flap compared to a muscle flap. Secondary surgical procedures for improving the aesthetic aspect were performed in 12% of the patients in the fasciocutaneous group and 0% in the muscle group. Conclusion Our results show that the most optimal aesthetic outcome is not defined by the type of flap. We found a strong correlation between physical functioning and the negative impact on social functioning that a reconstructed lower extremity may have. The result of this study can be taken into consideration during the shared-decision process of choosing the most optimal reconstruction.