Free Flap Harvesting From Paralyzed Limbs: A Systematic Review of Feasibility, Safety, and Functional Outcomes.

BACKGROUND: Free flap harvesting from paralyzed limbs represents a potentially valuable approach in reconstructive microsurgery, yet its safety and efficacy remain incompletely characterized. This systematic review evaluates the feasibility, safety, and outcomes of free flap harvesting from paralyzed limbs. METHODS: A comprehensive literature search was conducted across multiple databases for studies reporting free flap harvesting from paralyzed limbs. Studies were evaluated for flap type, etiology of paralysis, surgical outcomes, and complications. RESULTS: Nine studies (16 patients) met inclusion criteria, published between 2006 and 2025. Post-polio syndrome was the predominant etiology (15 patients, 93.8%), with one case of GNE myopathy. Anterolateral thigh flaps were most utilized (7 studies, 77.8%), followed by posterior tibial artery flaps (2 studies, 22.2%) and fibula flaps (1 study, 11.1%). All studies reported 100% flap success rates with no major complications. Minor complications included delayed wound healing (12.5%), infection (6.3%), and seroma formation (6.3%). Vascular anatomy remained intact despite long-standing paralysis, with perforators and pedicles comparable to those in neurologically intact limbs. No patient experienced functional decline in the paralyzed donor limb postoperatively. CONCLUSIONS: Free flap harvesting from paralyzed limbs demonstrates excellent reliability with minimal donor site morbidity. This approach preserves functional tissue in unaffected limbs-a critical consideration in patients with limited mobility. Despite muscle atrophy in paralyzed limbs, vascular integrity remains suitable for microsurgical transfer. For patients with paralysis requiring reconstruction, the paralyzed limb should be considered not merely an alternative but potentially a preferred donor site. Preoperative vascular assessment remains essential for optimal outcomes.