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J Reconstr Microsurg
DOI: 10.1055/a-2803-4658
Original Article

Title: Comparison of Surgical Time in TDAP Free Flap Procedures: Right vs. Left Donor Site

Authors

  • Yooseok Ha

    1   Department of Plastic and Reconstructive Surgery, Chungnam National University School of Medicine, Daejeon, Korea (the Republic of) (Ringgold ID: RIN90159)

  • Sukyoung Jung

    2   Department of Health Care Policy Research, Korea Institute for Health and Social Affairs, Sejong, Korea (the Republic of) (Ringgold ID: RIN50097)

  • Jeong Tae Kim

    3   Department of Plastic and Reconstructive Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea, Incheon, Korea (the Republic of)

  • Seung Eun Hong

    4   Department of Plastic and Reconstructive Surgery, School of medicine, Ewha Womans University, Seoul, Korea (the Republic of)

  • Youn Hwan Kim 

    5   Plastic and Reconstructive Surgery, Hanyang University College of Medicine, Seoul, Korea (the Republic of) (Ringgold ID: RIN37992)
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Background: While free flap reconstruction is well established, the influence of donor site laterality on operative efficiency has not been thoroughly explored. This study evaluated the effect of flap laterality (right vs. left) on operative time in thoracodorsal artery perforator (TDAP) free flap surgery, with a focus on ergonomic implications for right-handed surgeons. Methods: A retrospective review was conducted on patients who underwent TDAP free flap reconstruction at a single center. Operative times were compared between left- and right-sided flaps. Clinical variables, flap dimensions, and donor site closure techniques were analyzed. Multivariate regression was performed to assess the independent effect of laterality on operative duration, adjusting for confounders. Results: Left-sided TDAP flaps were associated with significantly longer operative times compared to right-sided flaps (p < 0.01). These cases also involved larger flap dimensions and more frequent use of skin grafts for donor site closure. Multivariate analysis confirmed that left-sided laterality independently predicted increased operative time. All procedures were performed by right-handed surgeons, suggesting ergonomic factors as a key contributor. Technical recommendations were proposed to improve efficiency during left-sided harvests. Conclusion: Donor site laterality significantly affects operative time in TDAP free flap reconstruction, likely due to ergonomic disadvantages for right-handed surgeons. Surgeons should consider laterality during preoperative planning and prioritize right-sided flaps when feasible. Incorporating ergonomic strategies into training and technique may enhance surgical efficiency and outcomes.



Publication History

Received: 20 August 2025

Accepted after revision: 13 January 2026

Accepted Manuscript online:
13 February 2026

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