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Figure 1. A representative case of TDAP-based VLVT for unilateral upper extremity lymphedema. (A) TDAP flap was harvested superficially to the superficial fascia for inset into the distal volar forearm. (B) Preoperative image showing significant swelling of the right upper extremity. (C) Measurements 3 months postoperatively show a significant reduction in the girth of the right upper extremity. The thin profile of VLVT flaps minimizes flap bulk; thus, contour deformity of the recipient site is avoided. TDAP: Thoracodorsal artery perforator; VLVT: vascularized lymph vessel transplant.