title: Plantar reconstruction with free thoracodorsal artery perforator flaps.
abstract: OBJECTIVE
  The plantar region presents unique challenges for reconstructive surgeons. Reconstruction using a thoracodorsal artery perforator (TDAP) flap yields favourable results in various fields of microsurgical reconstruction, but reports on the reconstruction of plantar defects are sparse. Here, the authors present their experience in the reconstruction of various defects in the plantar region using free TDAP flaps.
  
  
  METHODS
  From January 2005 to July 2011, 40 free TDAP flaps were transferred for reconstructive purposes to restore skin and soft-tissue defects in the plantar region. Hospital and outpatient records were reviewed independently for all patients. A patient questionnaire including five questions was administered to subjectively evaluate reconstructive results.
  
  
  RESULTS
  A total of 24 male and 16 female patients were enrolled in this study. The mean age was 47.8 years and ranged from 7 to 77 years. The most common cause of defect was oncology related (n=21), followed by trauma-related (n=11), diabetes-related (n=6) and other causes. The average flap size was 63.7 cm2 and ranged from 25 to 212 cm2. All flaps survived except for one, resulting in a below-knee amputation. The mean follow-up period was 20.4 months. Four patients underwent secondary revisional procedures, including simple defatting in two patients and excision of redundant skin due to flap instability in two patients. The satisfaction surveys were completed by 34 (85%) patients. Patients reported high levels of satisfaction in terms of pain, limitation of daily activities, donor site satisfaction and overall satisfaction. Most patients were satisfied and reported that they would recommend the procedure to others.
  
  
  CONCLUSIONS
  An appropriately thinned free TDAP flap with thick skin provided favourable outcomes with high patient satisfaction and is a valuable option for the restoration of skin and soft-tissue defects in the plantar region.
authors.affiliation: Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea.
authors.forename: Byung-Joon
authors.initials: BJ
authors.lastname: Jeon
authors.forename: Kyeong-Tae
authors.initials: KT
authors.lastname: Lee
authors.forename: So-Young
authors.initials: SY
authors.lastname: Lim
authors.forename: Jai-Kyong
authors.initials: JK
authors.lastname: Pyon
authors.forename: Sa-Ik
authors.initials: SI
authors.lastname: Bang
authors.forename: Kap-Sung
authors.initials: KS
authors.lastname: Oh
authors.forename: Goo-Hyun
authors.initials: GH
authors.lastname: Mun
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005534:Foot Diseases / Q000473:pathology / Q000601:surgery*; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061525:Perforator Flap / Q000098:blood supply*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D013895:Thoracic Arteries / Q000601:surgery / Q000637:transplantation; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult