Introduction: For a long time, the free or pedicled thoracodorsal artery perforator (TDAP) flaps were used for reconstruction of large cutaneous defects. These may be regional soft tissue defects of trunk, axilla and breast where the pedicled flap used, or distant tissue defects of face, elbow, forearm and lower extremity where the free TDAP flap is used. Aim of the Study: This study aimed to evaluate the clinical applications of the thoracodorsal artery perforator flap (TDAP) either free or pedicled in the reconstruction of soft tissue defects of extremities. Patients and Methods: This study was conducted on 20 patients admitted to the Plastic Surgery Departments of both Tanta & Al Azhar Universities during the period from September 2015 to December 2017. These patients were presented by extremity soft tissue defects that required a flap reconstruction. Results: The results showed that the TDAP flap is a versatile and robust flap in soft tissue reconstruction of the extremities. This flap has great advantages as a long vascular pedicle; large skin paddle can be harvested, minimal donor site morbidity and thin skin paddle to resurface shallow defects. The TDAP flap showed also some drawbacks like meticulous and time-consuming dissection of the perforators, donor site scar widening. Conclusion: TDAP flap is a versatile and an excellent flap either free or pedicled for extremity soft tissue reconstruction. It should be added to the workhorse perforator flaps.

Background: Reconstruction of soft tissue defects overlying the Achilles tendon has always been a challenge. Various modalities of reconstruction have been described to resurface such defects. We aimed to assess the functional and cosmetic outcomes of all patients who had undergone reconstruction of small and medium sized soft tissue defects of the Achilles region using local fasciocutaneous island flaps. Methods: This retrospective study was conducted from January 2020 to June 2022. 15 patients with small (≤ 30 cm 2 ) and medium (30-90 cm 2 ) sized soft tissue defects of the tendo-Achilles region, underwent reconstruction with local fasciocutaneous island flaps and had complete medical records, were included. Results: Thirteen patients were male (86.7%). The mean age was 53.2 years. 5 cases (33.3%) had post-traumatic open AT injuries with skin avulsion, while ten patients (66.7%) had suture line complications after open repair of spontaneous Achilles tendon rupture. Defect sizes ranged from 12 to 63 cm2. Reverse sural flap was used in 5 patients (33.3%) and medial plantar flap in 10 patients (66.7%). All flaps survived completely. Complications were detected in 3 patients (20%); 1 distal superficial necrosis in a sural flap and 2 marginal minimal graft loss. Functional outcome was good in 12 patients (80%), excellent in 1 patient (6.7%) and fair in 2 patients (13.3%). 13 patients (86.7%) were satisfied with the cosmetic results. Conclusion: Local fasciocutenous island flaps are reliable and simple solutions for covering small to moderate soft tissue defects overlying the Achilles Tendon, with acceptable functional and cosmetic outcomes.

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