Thin Thoracodorsal Artery Perforator Free Flap for Scalp Resurfacing After Malignant Skin Tumor Excision.

BACKGROUND: Scalp defects after malignant tumor excision often require free tissue transfer for durable coverage. The thoracodorsal artery perforator (TDAP) flap remains underused despite its suitability for thin elevation. METHODS: Fourteen patients (6 men, 8 women; mean age 62 years) treated with a thin TDAP free flap for scalp resurfacing after malignant tumor excision between 2016 and 2026 were retrospectively reviewed. All flaps were performed by a single surgeon at two institutions. RESULTS: TDAP elevation was completed in 14 of 16 attempts (87.5%); in 2 patients no reliable perforator was found at exploration and a latissimus dorsi flap was raised instead. Diagnoses included squamous cell carcinoma (6), basal cell carcinoma (3), basosquamous carcinoma (2), and single cases of eccrine porocarcinoma, angiosarcoma, and melanoma. Mean flap area was 97 cm2 and pedicle length 9.7 cm; superficial temporal vessels served as recipients, with single-artery, single-vein anastomosis per flap. Mean operative time, including excision, was 134 min. One venous thrombosis was salvaged by re-exploration, one flap showed transient venous congestion that resolved spontaneously, and all 14 flaps survived. Over a mean follow-up of 17 months, one patient with angiosarcoma developed regional and distant recurrence without local recurrence at the reconstructed site. CONCLUSIONS: The thin TDAP free flap is a reliable, efficient, and versatile option for oncologic scalp reconstruction.