Angle-Adjusted Transverse Thoracodorsal Artery Perforator Flap in Lower Extremity Reconstruction: A Case Series of 63 Patients

Background: The thoracodorsal artery perforator (TDAP) flap is a viable option for reconstructing various soft tissue defects. Despite its numerous benefits, including reduced donor site morbidity, the TDAP flap has not gained popularity because of its anatomical variations and technical challenges. Herein, we aimed to introduce the application of the angle-adjusted transverse TDAP flap in lower extremity reconstruction and provide novel perspectives, with emphasis of outcomes. Methods: We retrospectively analyzed data from patients who underwent lower extremity reconstruction using a novel, modified transverse-TDAP flap at a single center between 2015 and 2019. This modification introduced a more transverse pattern with an innovative angle adjustment of approximately 30°–60°, specifically designed to optimize coverage and adaptability to various defects and aimed to prevent irritation at the posterior aspect of the scar, which could otherwise lead to pain during rehabilitation—addressing a common challenge in traditional TDAP flap designs. We conducted a comprehensive assessment of the TDAP flap, including patient characteristics, surgical details, long-term outcomes, functional evaluation of donor site using the American Shoulder and Elbow Surgeons (ASES) Score, and postoperative complications. Results: Sixty-three consecutive patients who underwent TDAP free flap reconstruction were included. Mean follow-up duration was 54.3 months; most common etiology was trauma (25 cases; 39.7%), followed by diabetes (16 cases; 28.6%). Twenty-six cases (41.3%) involved lesions in the foot, and 11 (17.5%) involved lesions in the distal tibia. Complications included total flap loss in five patients and donor site complications in one patient. As assessed using the ASES, the average functional score of the donor site was 97.8 points. Conclusions: The modified transverse-TDAP flap provides favorable outcomes with minimal donor site morbidity, making it a viable alternative in clinical practice. Its design ensures effective coverage with reduced complications, establishing it as a reliable choice for lower extremity reconstruction.