A comparative study between free flap and skin grafting/self-healing for the closure of the foot donor site following digital reconstruction

Digital reconstruction often results in difficult donor site healing and impaired function. This study aimed to compare the effects of free flaps and skin grafting/self-healing on the repair of the donor site. This retrospective study involved 33 patients who underwent digital reconstruction from February 2019 to February 2024. Patients were divided into skin grafting/self-healing group (Group 1; n = 16) and free flaps group (Group 2; n = 17). The therapeutic effects were assessed by healing time and length of stay (LOS). The functional outcomes were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score and Foot Function Index-Verbal Rating Scale (FFI-5 pt), static Two-Point Discrimination (s2PD) test and Semmes-Weinstein Monofilament Test (SWMT) for sensory recovery and visual analogue scale (VAS) for pain. A questionnaire survey was conducted to assess patients’ satisfaction. Operative time was significantly shorter in Group 1 (3.8 [3.15–4.25] h) than in Group 2 (6.0 [5.0–7.0] h). Wound healing time was longer in Group 1 (30 [23.5–33.0] d) than in Group2 (21 [18.0–23.0] h). LOS was comparable between groups ( P > 0.05). Sensory recovery was superior in Group 2, as evidenced by better s2PD and SWMT results ( P < 0.05). Foot functional scores (AOFAS, FFI-5pt) and postoperative pain (VAS) showed no significant intergroup differences ( P > 0.05). Patient satisfaction was significantly higher in Group 1 ( P = 0.013). Skin grafting/self-healing achieved comparable functional outcomes to free flaps but required shorter operative time and yielded higher patient satisfaction, while free flap reconstruction offered faster wound healing and superior sensory recovery. These findings suggest that neither technique is universally superior; rather, the choice should be individualized based on defect characteristics and patient priorities. Therapeutic, III.