ABSTRACT
Perforator flaps for breast reconstruction along with preoperative imaging with both computed tomography and magnetic resonance imaging has opened a Pandora’s box of new flap options, including the profunda artery perforator flap. The thoracodorsal artery perforator (TDAP) flap was originally described in 1992 and involves harvesting the skin and a subcutaneous island in the territory of a traditional latissimus dorsi (LD)-musculocutaneous flap, but without inclusion of muscle. The TDAP flap should be considered as a reconstructive option when an autologous procedure is required and a conventional abdominal donor site is not available, or this approach, is declined by the patient and/or surgeon. The flap is planned with the patient in the standing position, with arms at the side, and hands on the waist. The patient is asked to actively contract the back muscles, at which time the antero-lateral border of the LD muscle is clearly defined under the skin and is marked with an indelible pen.
