The Toracoabdominal flap (TA) is basically a rotation-advancement flap that uses the lateral intercostals, subcostal, and lumbar arteries. An incision is made at the midline of the abdomen all the way down to the umbilicus, and further dissection proceeds inferiorly and laterally across a prefascial plane. The pedicle of this flap can be identified at the medial edge of the external oblique muscle and preserved. The flap is rotated clockwise for left chest wall defects, or counterclockwise for right chest wall defects. This flap is usually indicated when a higher portion of the defect lies medial, or a large amount of medial advancement is required. The TA flap uses the skin, subcutaneous tissue of the anterior abdominal wall, and the direct perforating vessels of the segmental arteries that arise from the subcostal, intercostals, and lumbar arteries. Epigastric perforators can also be preserved whenever possible. Deo et al. reported that this flap is better than the myocutaneous flap in terms of mean blood loss, operating time, and length of hospital stay, and Persichetti et al. have described using extended TA flaps to repair extensive defects ≤600 cm2
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