Comparison of the free thinned anterolateral thigh perforator flap with the free medial sural artery perforator flap for reconstruction of head and neck, and extremity defects.

<b><br>Introduction:</b> Free anterolateral thigh (ALTP) and free medial sural artery perforator (MSAP) flaps are time-tested donor tissues for reconstructing defects of the head and neck or extremities. Proponents of either type of flap have concluded each as workhorse flap in their large cohort studies. However, we could not find any papers in the literature objectively comparing donor morbidities or recipient site outcomes of these flaps.</br> <b><br>Methods:</b> Retrospective data, such as demographic details, flap characteristics and postoperative course, from patients who underwent free thinned ALTP (25 patients) and MSAP flap (20 patients) reconstruction were included. Donor site morbidity and recipient site outcomes were assessed at follow-up, using previously defined protocols, and were compared between the two groups.</br> <b><br>Results:</b> The free thinned ALTP (tALTP) flaps had significantly more pedicle length, vessel diameter and harvest time than the free MSAP flaps (p-value <.00). The incidence of hyperpigmentation, itching, hypertrophic scarring, numbness, sensory impairment and cold intolerance at the donor site were not statistically significant different between the two groups. Scarring at the free MSAP donor site was considered a significant social stigma (p-value = .005). Recipient site cosmetic outcome was comparable (p-value = .86), measured using an aesthetic numeric analogue.</br> <b><br>Conclusions:</b> A free tALTP flap is superior to a free MSAP flap in terms of pedicle length, vessel diameter and donor site morbidity, while the latter takes less time to harvest.</br>