AIM: This study aimed to explore the efficacy of anterolateral thigh perforator (ALTP) flap and peroneal artery perforator (PAP) flap transplantation and their influence on levels of pain and wound growth factors in elderly patients with soft tissue defects caused by foot trauma.

METHODS: A total of 98 elderly patients with foot trauma who underwent flap transplantation in the hospital from January 2022 to January 2024 were collected and analyzed retrospectively. Patients were divided into the ALTP group (n = 45, receiving ALTP flap transplantation) and the PAP group (n = 53, receiving PAP flap transplantation). Visual analogue scale (VAS) and American orthopedic foot and ankle society (AOFAS) score were used to assess the pain and functional outcome. Enzyme-linked immunosorbent assay (ELISA) kits were utilized to test the levels of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and hypoxia inducible factor 1 (HIF-1) in wound fluid.

RESULTS: The wound size in the ALTP group was larger than that in the PAP group (p < 0.001). Longer operative time, hospitalization time and greater intraoperative blood loss were noted in the ALTP group than in the PAP group (p < 0.001). Linear regression analysis showed that the surgical method was the main factor affecting operative time, hospitalization time and intraoperative blood loss (p < 0.001). The necrosis rate in the ALTP group (13.33%) was higher than that in the PAP group (3.77%), but the difference was not statistically significant (p = 0.176). Compared with the ALTP group, the VAS score of the PAP group was markedly reduced at 3 days and 1 week after surgery, and 1 month after follow-up (p < 0.001). 3 days after surgery, the levels of VEGF and bFGF of the PAP group were significantly increased compared with the ALTP group (p < 0.001). 1 week after surgery, the levels of bFGF of the PAP group were higher compared with the ALTP group (p = 0.003). The total incidence rate of complications in the ALTP group (25/44, 56.82%) was significantly higher than that in the PAP group (7/53, 13.21%) (p < 0.001). And multivariate logistic regression analysis showed that ALTP was the independent influencing factors for complications (p < 0.001). At 6 months after surgery, there was no significant difference in AOFAS scores between the two groups (p = 0.078).

CONCLUSIONS: ALTP and PAP flap transplantation were both suitable for the reconstruction of soft tissue defects caused by foot trauma in elderly patients, with the latter associated with shorter surgical time and hospitalization time, as well as better wound healing, less postoperative pain and fewer complications.