The Superior and Inferior Gluteal Artery Perforator Flaps

Abstract

Perforator flaps have allowed reconstruction of soft-tissue defects throughout the body. The superior and inferior gluteal artery perforator flaps have been used clinically, yet the published anatomical studies describing the blood supply to the gluteal skin are inadequate. This study comprehensively evaluated the anatomical basis of these flaps to present anatomical landmarks to facilitate flap dissection. In six fresh cadavers, the integument of the gluteal region was dissected. Cutaneous perforators of the superior and inferior gluteal arteries were identified. Their course, size, location, and type (septocutaneous versus musculocutaneous) were recorded based on dissection, angiography, and photography. The surface areas of cutaneous territories and perforator zones were measured and calculated. The average number of superior and inferior cutaneous perforators greater than or equal to 0.5 mm in the gluteal region was 5 +/- 2 and 8 +/- 4, respectively, with all of the superior and 99 percent of the inferior gluteal artery perforators being musculocutaneous. Their average perforator internal diameter was 0.6 +/- 0.1 mm. The average superior and inferior gluteal artery cutaneous vascular territory was 69 +/- 56 cm and 177 +/- 38 cm, respectively. The superior gluteal perforators were found adjacent to the medial two-thirds of a line drawn from the posterior superior iliac spine to the greater trochanter. The inferior gluteal artery perforators were concentrated along a line in the middle third of the gluteal region above the gluteal crease. The reliable size and consistency of the superior and inferior gluteal artery perforators allow the use of pedicled and free superior and inferior gluteal artery perforator flaps in a variety of clinical situations.