Background: Free tissue flaps from the foot have become an in- creasingly reliable tool in modern reconstructive surgery; however, the field lacks an empirical analysis focused on donor-site morbid- ity. This systematic review and meta-analysis aimed to evaluate the incidence of donor-site morbidity following dorsalis pedis and free toe flap harvest.
Methods: This systematic review and meta-analysis was per- formed according to the PRISMA guidelines. A systematic search of PubMed, Embase, CENTRAL, and clinicaltrials.gov was performed on March 3, 2025, to identify eligible studies involving adults who un- derwent free flap harvest from the toes or dorsum of the foot and reported postoperative donor-site morbidity outcomes. Eligible de- signs included case series ( ≥5 patients), observational studies, ran- domized controlled trials, and controlled clinical trials published in English. Letters, reviews, editorials, conference abstracts, and ani- mal and cadaveric studies were excluded. Two reviewers indepen- dently screened studies, extracted data, and assessed bias.
Results: We included 394 cases of free flap harvest (three stud- ies on dorsalis pedis flaps and 11 on toe flaps) across 14 stud- ies published between 20 0 0 and 2025. The percentage of pa- tients experiencing objective and subjective donor-site morbidity was 2.99% and 3.32% respectively. Wound dehiscence, delayed heal- ing, and hematoma were the most common objective complica- tions, while daily life disturbance, pain, and numbness occurred most frequently in the subjective morbidity domain.
Conclusions: The occurrence of donor-site morbidity is relatively low, although substantial heterogeneity limits the strength of these results. This review offers comprehensive insights into donor-site morbidity of foot free flaps, aiming to improve patient and physi- cian awareness.
