Thoracodorsal Artery Perforator Flap (TDAP or TAP) Westminster

The TDAP flap is comprised of the skin and fat of the midlateral back area that is supplied by the thoracodorsal artery and vein perforator but without disrupting the lattisimus dorsi muscle. Because no muscle is disrupted in this type of flap reconstruction, post-operative pain and morbidity is minimized. Thoracodorsal artery perforator flaps (or TDAP flaps) are typically used to fill small defects in extremities or in breasts after lumpectomy or partial mastectomy. The smaller size of this type of flap allows us to add extra volume, when used with breast defect reconstruction, or minimal bulkiness, when used in the extremities.

Figure 1. Thoracodorsal artery perforator location

Used initially for lower extremity reconstruction as early as 1995, the TDAP flap is now used in various forms of head, neck, breast and extremity reconstruction. The process of securing the flap begins by locating the thoracodorsal artery along the lateral back region with an external Doppler. Once located, an area around the artery sufficient for the surgical needs is marked off. The area of skin, subcutaneous tissue and superficial vessels are delicately resected along the descending branch of the thoracodorsal artery. The artery, vein, subcutaneous tissue and skin are tunneled under the skin to the defect area (or vessels ligated and flap transplanted distantly if necessary) and donor site closed. Once the flap is positioned to repair the defect, it is secured and area closed.

TDAP Flap Illustration

TDAP Flap Photo