PR21 PLANNING GLUTEAL ARTERY PERFORATOR FLAPS FOR BREAST RECONSTRUCTION WITH PREOPERATIVE IMAGING

Abstract

Background: While autologous breast reconstruction is frequently sought, donor sites providing versatility in volume with low donor site morbidity other than the abdominal wall are limited. Gluteal artery perforator flaps have been described in this role, however variations in individual vascular anatomy have resulted in the difficult planning of flaps, and particularly selection of whether superior or inferior gluteal artery perforators should be utilized.Methods: Five consecutive patients underwent a gluteal artery perforator flap for breast reconstruction. Preoperative imaging of the gluteal artery vasculature was undertaken with computed tomographic angiography (CTA). Both superior and inferior gluteal artery perforators were mapped on imaging, and the dominant system selected preoperatively. The anatomical basis, operative technique and outcomes are discussed.Results: In all cases, CTA was able to demonstrate individual vascular anatomy, and select the optimal perforators supplying the gluteal integument. Either a superior gluteal artery perforator (SGAP) or inferior gluteal artery perforator (IGAP) flap was planned, and undertaken successfully in each case. There was a 100% flap survival, with low donor site morbidity.Conclusion: With the use of preoperative planning, selection of either an SGAP or IGAP flap can be reliably made based on individual vascular anatomy. With low donor site morbidity and good aesthetic outcomes, gluteal artery perforator flaps are a good option in cases where the abdominal wall is not appropriate.