Primary and secondary outcomes
SEPARATION, SCAR
As a validated wound assessment tool, the Hollander Wound Evaluation Scale (HWES) was used as a primary outcome measure. The HWES consists of five subscales, and the wounds with a score of 6 were considered to have an optimal cosmetic appearance: step-off of borders (edges not on the same plane; 0 for yes, 1 for no), contour irregularities (wrinkled skin near the wound; 0 for yes, 1 for no), margin separation (gap between side; 0 for yes, 1 for no), edge inversion (wound not properly everted; 0 for yes, 1 for no), excessive distortion (swelling/edema/infection; 0 for yes, 1 for no), and overall appearance (subject appearance: 0 for poor, 1 for acceptable)Secondary outcome measures included the visual analog scale (VAS) and 5-item Likert scale to assess patient satisfaction with wound cosmesis. The VAS score was determined by measuring the distance (mm) on the 10-cm line between the “worst possible scar” anchor and the patient mark, providing a range of scores from 0 to 100Additionally, the Olerud–Molander Ankle Score (OMAS; scale, 0–100 points) was assessed at 6-month follow-up visits to measure the functional outcome. A higher OMAS indicates better outcomes and fewer symptoms