Although 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.

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.

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 that ergonomic factors are a key contributor to these differences. Technical recommendations were proposed to improve efficiency during left-sided harvests.

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.

This study was conducted in accordance with the ethical principles of the Declaration of Helsinki and was approved by the Institutional Review Board of Hanyang University Hospital (IRB No. 2025-01-008).

‡Yoo Seok Ha and Suk Young Jung contributed equally to this work.

Received: 20 August 2025

Accepted: 13 January 2026

Accepted Manuscript online:
13 February 2026

Article published online:
25 February 2026

© 2026. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA