Gluteal Artery Perforator Flap Research Articles

The superior gluteal artery perforator flap (S-GAP-Flap)

Superior gluteal artery perforator flap for breast reconstruction with autologous tissue (S-GAP-flap): With the introduction of perforator flaps for breast reconstruction with autologous tissue the gluteal region became again investigated as a possible donor site. With the S-GAP-flap breast reconstruction from the gluteal region is possible utilising skin and fat without muscle sacrifice. 52 S-GAP-flaps for autologous breast reconstruction with a flap loss rate of 7.7 % were performed at the Department of Plastic and Hand surgery, Behandlungszentrum Vogtareuth, Germany from 1997 till 2002. Although there is an obvious learning curve also with this free tissue transfer, the S-GAP-flap is a reliable alternative in autologous breast reconstruction, when tissue from the lower abdomen is not available.

Ischial pressure sore reconstruction using an inferior gluteal artery perforator (IGAP) flap

Perforator-flap technique has revolutionised the practice of free tissue transfer with the goal of muscle sparing for function and strength. These concepts are being widely explored for breast reconstruction. The field of pressure-sore reconstruction presents a new application for this technique, preserving muscle for function in ambulatory patients and for future reconstruction in paraplegic patients. Just as the superior gluteal artery perforator flap holds promise for sacral and trochanteric reconstruction, the inferior gluteal artery perforator flap may provide a muscle-sparing alternative for ischial reconstruction. A case report of the successful use of an inferior gluteal artery perforator flap for ischial pressure-sore reconstruction is described, including the surgical technique employed for flap harvest, and 2 year's follow-up.

Breast Reconstruction with the Superior Gluteal Artery Perforator (S-GAP) Flap

Breast Reconstruction with the Superior Gluteal Artery Perforator (S-GAP) Flap

The value of preoperative Doppler sonography for planning free perforator flaps.

The individual perforating vessels have a high degree of anatomical variation, therefore it is desirable to conduct a careful examination of them before undertaking a perforator flap operation. Because locating the vessels beforehand makes performing the operative procedure much easier, the aim of the present study was to assess the value of using simple acoustic Doppler sonography to plan a perforator flap operation. The vessel examinations were carried out before taking 46 free microvascular flaps from either the lower abdominal wall or the buttock for reconstructive breast surgery. The perforating vessels located were marked, and their position relative to the umbilicus or the most cranial point of the rima ani recorded using a coordinate system. In 40 patients, a perforator flap operation (deep inferior epigastric perforator flap, n = 32; superior gluteal artery perforator flap, n = 8) was actually carried out; in six of these patients, a myocutaneous flap was used because of the insufficient availability of perforating vessels. Before the operation, perforating vessels were marked for each patient, with an average of 7.3 for the deep inferior epigastric perforator flap and 6.5 for the superior gluteal artery perforator flap. Out of 286 vessels marked for later perforator flaps, 162 were identified during the operation. A preoperatively marked vessel was used in 37 of 40 patients. In the remaining patients, a vessel was used that had not been previously marked. The vertical and horizontal distance between the perforating vessels identified during the operation and the preoperative marks averaged 0.8 cm. The results show preoperative Doppler sonography to be useful for locating the position of individual perforating vessels, making it much easier to find them during the operation.

The superior gluteal artery perforator flap: an additional tool in the treatment of sacral pressure sores

We describe the use of a large skin–subcutaneous tissue flap based on one perforator of the superior gluteal artery (SGA) to reconstruct large midline posterior defects in one stage. The integrity of the gluteus muscles is preserved and we feel this is particularly important in non-paralysed patients. Donor sites were always closed primarily.Use of the superior gluteal artery perforator (SGAP) flap preserves the entire contralateral side as a future donor site. On the ipsilateral side, the gluteal muscle itself is preserved and all flaps based on the inferior gluteal artery are still possible. We recommend this flap in an area where reconstructive possibilities are limited, as it preserves other reconstructive flap options, both on the ipsilateral and contralateral sides.

The sensate free superior gluteal artery perforator (S-GAP) flap: a valuable alternative in autologous breast reconstruction

The superior and inferior myocutaneous gluteal free flaps have been considered as valuable alternatives to the latissimus dorsi or TRAM flap since 1975. The superior gluteal artery perforator (S-GAP) flap is the ultimate refinement of this myocutaneous flap as no gluteus maximus muscle is harvested. The flap is vascularised by one single perforator originating from the superior gluteal artery.This study summarises the prospectively gathered data on 20 free S-GAP flaps used for breast reconstruction in 16 patients. Immediate reconstruction was performed in six breasts and delayed in 14 breasts. Mean follow-up was 11.1 months.Two risk factors, Raynaud’s disease and radiotherapy, were the cause of flap revision in two different patients. Total flap loss occurred in one case. Partial flap loss was not observed and a small area of fat necrosis was diagnosed by mammography in one other patient. All flaps were anastomosed to the internal mammary vessels at the 3rd costochondral junction. The anatomy of the sensate nerves of the S-GAP flap is described. Two nervous repairs provided early sensory recovery.The free S-GAP flap has become my personal second choice for autologous breast reconstruction after the DIEP (deep inferior epigastric perforator) flap. The S-GAP flap is indicated in patients with an asthenic body habitus or with excessive abdominal scarring. The advantages are the abundance of adipose tissue in this area even in thin patients, a long vascular pedicle, a hidden scar, improved projection of the reconstructed breast compared to the DIEP and TRAM flaps and the preservation of the entire gluteus maximus muscle. The donor morbidity is extremely low.

Surgical-technical aspects of the free diep flap for breast reconstruction

The transverse rectus abdominis myocutaneous (TRAM) flap has been the gold standard for breast reconstruction in the last decade. The free deep inferior epigastric perforator (DIEP) flap and the superior gluteal artery perforator (S-GAP) flap are both refinements or “upgrades” of the conventional myocutaneous lower abdominal and gluteal flaps. The harvested skin and fat paddles are similar but none of the underlying muscle is sacrificed. The preservation of the continuity of the muscle fibers, the muscle's motor innervation, and the vascularization by collateral blood vessels ensures normal function of the muscle, only split during surgery, and the muscles that interact with it. The free DIEP and S-GAP flap have comparable complication rates to the free TRAM flap, making these flaps safe and reliable techniques. Although still a very low risk is involved, especially total flap loss, free perforator flap surgery for breast reconstruction is the surgical technique in which the least perioperative and postoperative complications are involved and this offers the patient the best long-term aesthetic result. Additionally, by sparing the donor site muscle and restoring sensation, the normal breast anatomy is imitated in the best possible way; except for a donor site scar, no other damage is caused to the body. The free DIEP flap is the first choice for breast reconstruction because of the inherent characteristics of the lower abdominal wall.

The Superior Gluteal Artery Perforator Flap

The gluteal region is an excellent donor site for autogenous breast reconstruction, particularly when the lower abdomen is not suitable. The superior gluteal perforator flap involves microsurgical transfer of skin and fat from the buttock without muscle sacrifice. Gluteal myocutaneous flaps have been described, but they have several problems, including a short vascular pedicle, exposure of the sciatic nerve, and recipient vessel size discrepancy needing vein grafts.