Direct closure of the posterior tibial artery flap donor site defect with an open envelope incision: a prospective non-randomized clinical study.

The purpose of this study was to assess the safety and efficacy of an open envelope incision (OEI) for closure of the posterior tibial artery free flap (PTAFF) donor site and to compare the functional and aesthetic outcomes with those of closure using a triangular full-thickness skin graft (FTSG). This prospective study, conducted between April 2021 and February 2023, included 40 consecutive patients who underwent oral reconstruction using a PTAFF after ablative surgery. The patients were divided into two groups according to the donor site closure method: OEI (20 patients) or FTSG (20 patients). The primary outcome was the safety and efficacy of OEI for achieving primary healing of the PTAFF donor site. Secondary outcomes included the functional and aesthetic outcomes of the donor leg and their impact on patient quality of life. All modified PTAFF were harvested successfully. Significant differences were observed between the OEI and FTSG groups in leg oedema (10% vs 45%, P = 0.031) and numbness (15% vs 50%, P = 0.014). Better aesthetic and functional results were also seen in the OEI group. OEI is a reliable technique for PTAFF donor site closure, reducing donor site morbidity and avoiding a secondary donor site.