The Chimeric Thoracodorsal Artery Perforator Flap for Reconstruction After Buccal Cancer Resection: A Retrospective Case Series.

Abstract

Reconstruction of complex three-dimensional buccal defects after oncologic resection remains challenging. The chimeric thoracodorsal artery perforator (C-TDAP) flap offers versatile tissue components for single-stage reconstruction. This retrospective case series included 11 patients who underwent buccal carcinoma resection and immediate reconstruction with a C-TDAP flap between March 2022 and January 2024. Surgical technique, flap design, perioperative outcomes, complications, and early functional results (UW-QOL at ≥ 3 months) were analyzed. C-TDAP flaps were successfully harvested in all 11 patients, including four with an osseous component (scapular tip). Mean flap harvest time was 46.7 ± 8.3 min. Full-thickness cheek defects (n = 5) were reconstructed with a bi-paddled design. Postoperative complications included one donor-site shoulder dysfunction (Grade II). At a median follow-up of 10 months, 10 patients were disease-free; one patient with stage IVB disease was alive with local recurrence. UW-QOL scores at ≥ 3 months postoperatively indicated acceptable early function across multiple domains. The C-TDAP flap is a technically feasible and versatile option for reconstructing complex buccal defects. Its ability to provide multiple tissue components in a single stage enables customized three-dimensional reconstruction with acceptable morbidity.