Thoracodorsal artery perforator (TAP) flap: report of our experience and review of the literature.

We report our experience with the thoracodorsal artery perforator flap. Its use and pitfalls are critically highlighted, especially in terms of its application as an island flap. Publications on this recently described flap are scarce, possibly because it is rarely used as a result of the high level of skill needed in its preparation. In our hospital, we have used this flap twice as an island flap, both of which failed, and ten times as a free flap, one of which failed. Transfer as a free flap is a delicate procedure involving transmuscular vessel preparation; transposition as an island flap is limited by range. Based on our limited experience, we recommend this flap only in very selected cases. This procedure has to be performed by experienced microsurgeons, after training on cadavers, and after preoperative colour Doppler imaging to determine the precise location of the main perforators. Use of this perforator flap is indicated in cases where a long vascular pedicle for an appropriate free tissue transfer is necessary, and where aesthetic appearance and minimising donor-site morbidity are more important than a potentially high risk of failure.