{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T23:28:14Z","timestamp":1786663694234,"version":"build-2736575974"},"reference-count":35,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The anterolateral thigh (ALT) and parascapular (PS) flaps are commonly used fasciocutaneous free flaps for extremity reconstruction, offering large reliable soft tissue coverage with low donor site morbidity. However, comparative data on donor site functional outcomes remain limited. This review evaluates and compares reported donor site morbidity associated with ALT and PS flaps.<\/jats:p>\n                  <jats:p>A systematic review of MEDLINE, Embase, Scopus, and the Cochrane Library was conducted through October 6, 2025. Studies reporting binary outcomes for donor site complications after ALT or PS flap harvest were included. Data on hematoma, seroma, delayed healing, dehiscence, weakness, functional deficit, and numbness were pooled and analyzed using Fisher's exact or Chi-square tests.<\/jats:p>\n                  <jats:p>Of 1,167 studies screened, 46 met inclusion criteria: 43 reported on ALT flaps, 2 on PS flaps, and 1 on both, totaling 3,380 ALT and 50 PS flaps. For ALT flaps, pooled complication rates were: numbness 51.7%, dehiscence 9.6%, delayed healing 7.5%, weakness 5.0%, seroma 4.5%, functional deficit 1.5%, and hematoma 1.3%. For PS flaps, complication rates were: numbness 26.3%, dehiscence 16.7%, delayed healing 10.0%, weakness 10.0%, functional deficit 10.0%, seroma 8.0%, and hematoma 0%. ALT flaps were associated with significantly greater numbness (p\u2009=\u20090.01), while PS flaps showed higher functional deficits (p\u2009=\u20090.04). No other outcomes differed significantly.<\/jats:p>\n                  <jats:p>ALT and PS flaps both offer effective reconstruction with low overall morbidity. ALT flaps are more often associated with numbness, while PS flaps may pose a higher risk of functional impairment; however, this latter finding should be interpreted cautiously given the limited number of PS flap studies and small sample size. These differences may guide flap selection when clinical factors are otherwise equivalent.<\/jats:p>","DOI":"10.1055\/a-2920-3973","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:53:51Z","timestamp":1785538431000},"source":"Crossref","is-referenced-by-count":0,"title":["Anterolateral Thigh Versus Parascapular Fasciocutaneous Free Flap Donor Site Morbidity: A Systematic Review"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2907-5420","authenticated-orcid":false,"given":"Malia","family":"Voytik","sequence":"additional","affiliation":[{"name":"University of Pennsylvania, Pennsylvania, United States","place":["Philadelphia"],"department":["Department of Surgery, Division of Plastic and Reconstructive Surgery"]},{"name":"Christiana Care Health Services Inc, Delaware, United States","place":["Newark"],"department":["Department of Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salman","family":"Khan","sequence":"additional","affiliation":[{"name":"University of Pennsylvania, Pennsylvania, United States","place":["Philadelphia"],"department":["Department of Surgery, Division of Plastic and Reconstructive Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Piwnica-Worms","sequence":"additional","affiliation":[{"name":"University of Pennsylvania, Pennsylvania, United States","place":["Philadelphia"],"department":["Department of Surgery, Division of Plastic and Reconstructive Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Greenblatt","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University, Pennsylvania, United States","place":["Philadelphia"],"department":["College of Life Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jovial","family":"Joseph","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University Sidney Kimmel Medical College, Pennsylvania, United States","place":["Philadelphia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie","family":"Lee","sequence":"additional","affiliation":[{"name":"Drexel University College of Medicine, Pennsylvania, United States","place":["Philadelphia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina","family":"McShea","sequence":"additional","affiliation":[{"name":"University of Pennsylvania Libraries, Pennsylvania, United States","place":["Philadelphia"],"department":["Holman Biotech Commons"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robyn","family":"Broach","sequence":"additional","affiliation":[{"name":"University of Pennsylvania, Pennsylvania, United States","place":["Philadelphia"],"department":["Department of Surgery, Division of Plastic and Reconstructive Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ines C.","family":"Lin","sequence":"additional","affiliation":[{"name":"University of Pennsylvania, Pennsylvania, United States","place":["Philadelphia"],"department":["Department of Surgery, Division of Plastic and Reconstructive Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1002\/hed.21204","article-title":"Anterolateral thigh flap","volume":"32","author":"C H Wong","year":"2010","journal-title":"Head Neck"},{"issue":"07","key":"ref2","doi-asserted-by":"crossref","first-page":"2219","DOI":"10.1097\/00006534-200206000-00007","article-title":"Have we found an ideal soft-tissue flap? 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assessment of the donor site","volume":"124","author":"Y R Kuo","year":"2009","journal-title":"Plast Reconstr Surg"},{"issue":"12","key":"ref15","doi-asserted-by":"crossref","first-page":"1621","DOI":"10.1016\/j.bjps.2011.07.015","article-title":"Critical assessment of the anterolateral thigh flap donor site","volume":"64","author":"W A Townley","year":"2011","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"12","key":"ref16","doi-asserted-by":"crossref","first-page":"2105","DOI":"10.1016\/j.jcms.2017.09.022","article-title":"Donor site morbidity of the anterolateral thigh flap","volume":"45","author":"H Weise","year":"2017","journal-title":"J Craniomaxillofac Surg"},{"issue":"01","key":"ref17","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1097\/PRS.0b013e3181c495ed","article-title":"A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients","volume":"125","author":"M M 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comparison of donor site morbidity","volume":"66","author":"A Loreti","year":"2008","journal-title":"J Oral Maxillofac Surg"},{"issue":"06","key":"ref21","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1111\/odi.13354","article-title":"Full cheek defect reconstruction using ALTF versus RFF: comparison of quality of life, clinical results, and donor site morbidity","volume":"26","author":"B Zhou","year":"2020","journal-title":"Oral Dis"},{"issue":"02","key":"ref22","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1089\/fpsam.2022.0155","article-title":"Anterolateral thigh free flap versus thigh split thickness skin graft: comparison of morbidity in the first 30 days","volume":"25","author":"T Benjamin","year":"2023","journal-title":"Facial Plast Surg Aesthet Med"},{"issue":"01","key":"ref23","first-page":"7","article-title":"Anterolateral thigh cutaneous flap vs. radial forearm free-flap in oral and oropharyngeal reconstruction: an analysis of 48 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reconstruction in tongue cancer patients","volume":"24","author":"L Meng","year":"2019","journal-title":"Med Oral Patol Oral Cir Bucal"},{"issue":"03","key":"ref27","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1007\/s00238-021-01889-z","article-title":"Donor site aesthetic and functional outcomes: comparison between radial forearm free flap and anterolateral thigh free flap","volume":"45","author":"G Molteni","year":"2022","journal-title":"Eur J Plast Surg"},{"issue":"04","key":"ref28","first-page":"448","article-title":"Radial forearm versus anterolateral thigh free flaps for laryngopharyngectomy defects: prospective, randomized trial","volume":"39","author":"A T Morrissey","year":"2010","journal-title":"J Otolaryngol Head Neck Surg"},{"issue":"02","key":"ref29","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1055\/s-0037-1607323","article-title":"Soft tissue coverage in distal lower extremity open fractures: comparison of free anterolateral thigh and free 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reconstruction","volume":"32","author":"M S Tamimy","year":"2009","journal-title":"Eur J Plast Surg"},{"issue":"05","key":"ref33","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1055\/s-0040-1718550","article-title":"Improving outcomes in anterolateral thigh flap donor-site reconstruction using propeller flaps: a retrospective comparative study with skin grafting","volume":"37","author":"D Pagliara","year":"2021","journal-title":"J Reconstr Microsurg"},{"issue":"03","key":"ref34","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1055\/s-0038-1672126","article-title":"Reduced anterolateral thigh flap donor-site morbidity using incisional negative pressure therapy","volume":"35","author":"G Mangelsdorff","year":"2019","journal-title":"J Reconstr Microsurg"},{"issue":"08","key":"ref35","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1055\/s-0033-1351394","article-title":"Comparison of donor-site morbidity and satisfaction between anterolateral thigh and parascapular free flaps in the same patient","volume":"29","author":"S Fischer","year":"2013","journal-title":"J Reconstr Microsurg"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2920-3973.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T22:59:32Z","timestamp":1786661972000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2920-3973"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,31]]},"references-count":35,"URL":"https:\/\/doi.org\/10.1055\/a-2920-3973","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"value":"0743-684X","type":"print"},{"value":"1098-8947","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,7,31]]},"published":{"date-parts":[[2026,7,31]]}}}