Anterolateral Thigh Versus Parascapular Fasciocutaneous Free Flap Donor Site Morbidity: A Systematic Review

Introduction: 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. Methods: 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. Results: Of 1167 studies screened, 46 met inclusion criteria: 43 reported on ALT flaps, 2 on PS flaps, and 1 on both, totaling 3380 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=0.01), while PS flaps showed higher functional deficits (p=0.04). No other outcomes differed significantly. Conclusions: 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.