Short Pedicle Research Articles

Right Colonic Transposition Technique: When the Left Colon Is Unavailable for Achieving a Pelvic Anastomosis

On occasion, the left colon is not available for rectal or low pelvic anastomosis either because of synchronous pathology, previous resections, or inadequate blood supply. The short middle colic pedicle prevents use of the transverse colon for this purpose. In this situation, the right colon is a good anastomotic conduit. The aim of this video is to demonstrate the right colonic transposition technique. Intraoperative footage was filmed and edited in a multimedia format. Operative details were as follows: the diseased left colon and transverse colon are excised; the right colon is fully mobilized and transposed 180 degrees anticlockwise around the axis of the ileocolic pedicle, so the hepatic flexure reaches into the pelvis without tension. The hepatic flexure is then used for anastomosis within the pelvis either to the residual rectum or anus (see Supplemental Digital Content, Videos 1-3, http://links.lww.com/DCR/A46, http://links.lww.com/DCR/A47, and http://links.lww.com/DCR/A48). Case notes were reviewed to analyze clinical outcome and bowel function. Three patients underwent the technique, 2 females and 1 male (median age, 45 (range, 30-55) years). Median operating time was 98 (range, 95-114) minutes. There were no anastomotic failures or other major complications. One patient had a superficial wound infection. The median in-hospital stay was 7 (range, 7-8) days. The median time to first bowel movement was 3 (range, 3-4) days; the median daily stool frequency was 4 (range, 3-4) on discharge, decreasing to 2 daily stools 12 months after surgery. Stoma formation and total colectomy were successfully avoided in each patient. Right colonic transposition is a useful technique to enable the construction of a tension-free rectal anastomosis with a good blood supply. The use of the right colon in these clinicopathological situations can be achieved with low morbidity and results in good short- and long-term bowel function in these patients. Careful preservation of the ileocolic pedicle and division of the right colic vessels are essential to facilitate successful anastomosis.

Biomechanical Evaluations of Various C1-C2 Posterior Fixation Techniques

A biomechanical in vitro study using human cadaveric spine. To compare the biomechanical stability of pedicle screws versus various established posterior atlantoaxial fixations used to manage atlantoaxial instability. Rigid screw fixation of the atlantoaxial complex provides immediate stability and excellent fusion success though has a high risk of neurovascular complications. Some spine surgeons thus insert shorter C2 pedicle or pars/isthmus screws as alternatives to minimize the latter risks. The biomechanical consequences of short pedicle screw fixation remain unclear, however. Seven human cadaveric cervical spines with the occiput attached (C0-C3) had neutral zone (NZ) and range of motion (ROM) evaluated in three modes of loading. Specimens were tested in the following sequence: initially (1) the intact specimens were tested, after destabilization of C1-C2, then the specimens underwent (2) C1 lateral mass and C2 short pedicle screw fixation (PS-S), (3) C1 lateral mass and C2 long pedicle screw fixation (PS-L), (4) C1 lateral mass and C2 intralaminar screw fixation (ILS), (5) Sonntag's modified Gallie fixation (MG) and (6) C1-C2 transarticular screw fixation with posterior wiring (TAS 1 MG). (7) The destabilized spine was also tested. All instrumented groups were significantly stiffer in NZ and ROM than the intact spines, except in lateral bending, which was statistically significantly increased in the TAS 1 MG group. The MG group's NZ and ROM values were statistically significantly weaker than those of the PS-S, PS-L, and the ROM values of the TAS 1 MG groups. The ILS group's NZ values were higher than those of the TAS 1 MG group and for ROM, than that of the PS-S and PS-L groups. In flexion, the NZ and ROM values of the TAS 1 MG group were significantly less than those of the PS-S, PS-L, ILS, and MG groups. In axial rotation, the NZ and ROM values of the MG group were statistically significantly higher than those of the PS-S, PS-L, ISL and TAS 1 MG groups. The TAS 1 MG procedures provided the highest stability. The MG method alone may not be adequate for atlantoaxial arthrodesis, because it does not provide sufficient stability in lateral bending and rotation modes. The C2 pedicle screw and C2 ILS techniques are biomechanically less stable than the TAS 1 MG. In the C1 lateral mass-C2 pedicle screw fixation, the use of a short pedicle screw may be an alternative when other screw fixation techniques are not feasible.

Thoracic spine fractures: injury profile and outcomes of a surgically treated cohort

There are only few reports in literature about the treatment of traumatic lesions of the thoracic spine. They have been grouped together with thoracolumbar fractures, ignoring the particular biomechanics of the thoracic segment. The objective of this retrospective cohort is to describe the clinical presentation and outcomes of surgically treated patients with these injuries. Data were obtained from the institutional database of medical registries, identifying all the patients who had been treated for thoracic spine fractures, from January 1, 1995 through December 31, 2005 in our institution. The study group included the 51 surgically treated patients. General and surgery-related complications were considered as clinical outcomes and injury-related disability was also assessed. Statistical analysis evaluating possible associations with timing and type of surgery, neurological impairment and associated injuries was carried out. Motor vehicle accident was the most frequent mechanism of injury. Six patients had an incomplete neurological deficit, whereas 22 had a complete lesion. Thirty-two patients presented at least one complication. Five of the neurologically intact patients, while 20 of those with neurological impairment presented general complications (p = 0.0001). None of the patients' neurological status deteriorated after surgery. All patients with complete spinal cord injury and those with incomplete cord injury with partial functional recovery received disability compensation. Short pedicle instrumentations should be used whenever possible, but also long instrumentations and mixed constructs may be necessary for the management of such unique fractures.

Short Interposed Pedicle of Flow-Through Anterolateral Thigh Flap for Reliable Reconstruction of Damaged Upper Extremity

In microvascular reconstructive surgery, the recipient vessel in free flap transfer is often sacrificed to provide the vascular pedicle anastomosis. As the recipient vessel is likely to be necessary for distal circulation in the damaged upper extremity, preserving its patency is critical. Flow-through anastomosis is one method that preserves the recipient vessel's patency. We present here eight patients who underwent upper-extremity reconstructions with a free flow-through anterolateral thigh flap. The flap's short vascular pedicle was interposed into a division of the radial artery and anastomosed on both sides of the pedicle's T-shaped arterial segment. The flow-through flap has various advantages, not only making it possible to reconstruct both vessels and soft tissues but also preserving recipient vessels and balancing the blood supply or pressure in the flap. In clinical situations that do not require reconstruction of the artery, the short interposed pedicle of the free anterolateral thigh flow-through flap offers a versatile and reliable option for microsurgical reconstruction of defects in the upper extremities.

Les transferts articulaires vascularisés à partir du pied

Complete destruction of the PIP or MCP joint space can be treated by a vascularized transfer from the foot in selected patients. The surgical technique for PIP and MTP vascularised transplantation is described with special emphasis on recent improvements (use of a short vascular pedicle, refinements in donor site reconstruction). Results of a series of 50 transfers performed between 1992 and 2009 are presented. PIP transfer was performed in 37 patients, at an average age of 18.3 years (range 3 to 40) leading to an average active ROM of 44° (0–80), with a lag of extension of 34.2° (0–80). MCP transfer was performed in 12 patients (13 transfers), at an average age of 21.3 years (range 3 to 40) leading to an average range of motion of 60° (35–80), with a lag of extension of 18.6° (0–30). None of the reconstructed articulations was painful. On the plain radiographs, no degradation of the joint space of the transferred articulations was noted. Within the pediatric population, the growth potential was preserved, signing the perenniality of the vascularization of the transfers. When faced to a complete joint destruction involving either the PIP or the MCP of the long fingers, reconstruction can be achieved by the mean of a vascularized joint transfer. The range of motion obtained with these transfers is not superior to what is observed after arthroplasty but it will persist with time. Therefore, even it is a technically demanding option, it should remain in our armamentarium as an alternative to joint fusion or joint arthroplasty.

Disc Height Change Following Thoracolumbar Burst Fractures Treated with Pedicle Screw Fixation without Fusion

Indirect reduction and posterior pedicle screw fixation have been reported with variable outcomes. However, there is no study that reports on disc space height change following short segment pedicle screw instrumentation without fusion.

Antler Transformation is Advanced by Inversion of Antlerogenic Periosteum Implants in Sika Deer (Cervus nippon)

Deer antlers offer a unique model for the study of tissue-specific stem cells and organogenesis, as antler stem cells are confined to the antlerogenic periosteum (AP), a tissue that can be readily located (overlying a frontal crest) and experimentally manipulated. AP consists of an upper fibrous layer and a lower cellular layer. Tissue transplantation and membrane insertion experiments demonstrated that antler formation is triggered by the interactions between AP and the overlying skin. Interestingly, fairly normal antlers can be induced to grow by an inverted AP implant (the AP cellular layer facing the skin) at an ectopic site, raising the question whether the initial inductive signal is derived from the fibrous layer or cellular layer or both. To answer this question, in this study we used eight sika deer stag calves and selected one side of future antler growth region for implanting inverted AP and the contralateral side for noninverted AP as the control. The results showed that implantation of the AP discs in an inverted orientation generated pedicles with final height (17 ± 5.1 mm), less than half the height of those formed from the noninverted AP implants (45 ± 11.7 mm). Critically, antler transformation was initiated from a shorter pedicle, which was formed from the region where the AP cellular layer was brought in close proximity to the overlying skin. Therefore, the AP cellular layer, as opposed to the AP fibrous layer, is likely to be the main source of the initial inductive molecules for antlerogenesis.

Perforator Flaps in Head and Neck Reconstruction

Free tissue transfer has revolutionized the management of complex head and neck defects. Perforator flaps represent the most recent advance in the development of free flap surgery. These flaps are based on perforating vessels and can be harvested without significant damage to associated muscles, thereby reducing the postoperative morbidity associated with muscle-based flaps. Elevation of perforator flaps requires meticulous technique and can be more challenging than raising muscle-based flaps. Use of a Doppler device enables reliable identification of the perforating vessels and aids in the design of free-style free flaps, where the flaps are designed purely according to the perforator located. The major advantage of free-style free flaps is that an unlimited number of flaps can potentially be designed on much shorter pedicles. The anterolateral thigh flap is the most commonly used perforator flap in head and neck reconstruction. Its use is described in detail, as is use of other less common perforator flaps. This article also describes head and neck reconstruction in a region-specific manner and gives a short-list of suitable flaps based on the location of the defect.

Transossäre Gefäßführung bei mikrochirurgischem Gewebetransfer

In cases of damaged recipient vessels or short vascular pedicles of the flaps, arteriovenous loops or long vein interposition are necessary for microsurgical defect coverage. These procedures require additional anastomoses with extended access and prolonged surgery and increase the risk of complications.The following article presents an alternative transosseous route of vascular pedicles for improved access to the recipient vessel based on three case studies.

E-018 Preliminary experience with the percutaneous embolization of paragangliomas at the carotid bifurcation using only Onyx

Introduction and purposeSurgical resection of hypervascular paraganglioma can be difficult due to intraoperative blood loss. Preoperative endovascular embolization with particulate material facilitates safe and complete surgical resection. However, complete devascularization...

Bioerosion structures and their distribution on shells of the Lower Pleistocene terebratulid brachiopod Gryphus minor

We present an analysis of bioerosion structures occurring on the shells of a Gryphus minor fossil population from Reggio Calabria (S. Italy), Early Pleistocene (Calabrian) in age. This population belongs to a palaeobiocoenosis that can be compared with present-day detritic terrigenous mud outer circalittoral environment. The assemblage includes 5 different brachiopod species, but it is dominated by Gryphus minor. We analyzed all of the 4069 Gryphus individuals in search of shell damage due to biological activity (bioerosion). About 12% of the specimens were affected to some extent. Bioerosion traces were identified down to the ichnospecies level and ascribed to potential biological agents (predators, epibionts or endobionts). Evidence for predation (Praedichnia) is limited, whereas etchings for attachments (Fixichnia) are more common. In particular, 453 traces belong to Podichnus obliquus, an ichnotaxon that describes a distinctive etching scar due to the pedicle attachment of other brachiopods on the shell. In the case of Gryphus minor, Podichnus were caused by conspecifics. Podichnus distribution on the shells, and its shape, suggest that Gryphus minor had a somewhat short pedicle, and lived with the umbo close to the substrate.

Non-fusion without decompression for surgical treatment of unstable AO type A thoracolumbar fractures

Objective To discuss the role of non-fusion without decompression in surgical treatment of unstable AO type A thoracolumbar fractures. Methods A retrospective study was performed on 42 patients with AO type A thoracolumbar fractures (T11-L2) treated with short segment pedicle screw fixation from February 2004 to February 2008. Patients were divided into two groups, ie, Croup A (treated with short segmental pedicle screw fixation without decompression or fusion) and Group B (treated with short segmental pedicle screw fixation without decompression but with fusion). The pre-operative, postoperative and follow-up local kyphotic angle, vertebrae compression rate were compared between two groups. Results In Croup A, average local kyphotic angle and average vertebrae compression rate were 19.1° (15. 4°-29. 8°) and 46% (30%-63%) respectively before operation, but 5. 0° (0. 3°-10.3°) and 10% (0-28%) respectively after operation. Twenty-one patients were followed up for average 21.2 months (12-46 months), which showed average local kyphotic angle of 7° (1.8°-10.7°) and average vertebrae compression rate of 10% (2% -22%) at final follow-up. In Croup B, average local kyphotic angle and average vertebrae compression rate were 25.8° (15.9°-34.5°) and 55% (30%-76%) respectively before operation, but 7.1° (1.5°-19. 1°) and 15% (0-28%) respectively after operation. Fifteen patients were followed up for mean 17.9 months (12-31 months) , which showed mean local kyphotic angle of 8.3° (0.7°-19.2°) and average vertebrae compression rate of 15% (l%-26%) at final follow-up. There was no pseudarthrosis, implant breakage, pedicle screw pull-out or severe back pain. There was statistical difference in local kyphotic angle and vertebrae compression rate between two groups.Conclusion Unstable AO type A thoracolumbar fractures with minor neurological deficit can be treated with pedicle screw fixation only without decompression or fusion. Key words: Spinal fractures; Thoracic vertebrae; Lumbar vertebrae; Fracture fixation, internal; Bone fusion

Prevention of thoracolumbar osteoporotic compression fracture with transpedicular intracorporeal bone graft with allogenic bone

Objective To evaluate the clinical efficacy of transpedicular intracorporeal bone graft with allogenic bone in treatment of thoracolumbar osteoporotic compression fracture. Methods A total of 45 patients with thoracolumbar osteoporotic compression fractures were treated with posterior short segment pedicle screw fixation and transpedicular intracorporeal bone graft with allogenic bone. Anteroposte-rior and lateral X-ray photographs were taken before and after operation and at follow up period to determine the ratio of anterior and middle compressed body height to the normal height, the vertebral angle and the superior-inferior endplate angle. The extent of local pain was measured by VAS score. The implant failure was also recorded during follow-up. Results The operative reduction and interbody bone grafting exerted a satisfactory effect on the ratio of anterior and middle body height to the normal height, the vertebral angle and the superior-inferior endplate angle. Local back pain disappeared immediately after surgery in 34 patients out of 38 patients followed up for more than two years. No implant failure was found during follow-up. Conclusions Early treatment with posterior short segment pedicle screw fixation and transpedicular intracorporeal bone graft with allogenic bone can effectively correct local deformity, prevent late vertebral collapse and implant failure and is an ideal treatment method for thoracolumbar osteoporotic compression fracture. Key words: Spinal fractures; Thoracic vertebrae; Lumbar vertebrae; Osteoporosis; Allogenic bone

Chronic Iron‐deficiency Anemia Caused by a Jejunojejunal Intussusception on a Solitary Hamartomatous Polyp

Chronic Iron‐deficiency Anemia Caused by a Jejunojejunal Intussusception on a Solitary Hamartomatous Polyp

Various Modifications to Internal Mammary Vessel Anastomosis in Breast Reconstruction with Deep Inferior Epigastric Perforator Flap

Free autologous tissue transfer has been used in mastectomized patients for high-quality reconstruction. Since the deep inferior epigastric perforator flap was developed, it has been considered preferable owing to reduced donor site morbidity. At our institution, anastomosis of internal mammary vessels has been top priority because of better positioning and shorter pedicle length. We publish our experiences with various technical modifications that assure internal mammary vessel anastomosis. From 2003 to 2008, 35 patients received free deep inferior epigastric perforator flap for breast reconstruction by anastomosis with internal mammary vessels. Twenty-nine reconstructions were done immediately upon mastectomy whereas six were delayed. The patterns of anastomosis between the flap pedicle and internal mammary vessel were categorized and the results were followed by flap survival and complications. These deep inferior epigastric perforator flaps were all supplied by a single pedicle artery. Twenty-five of them were drained by a single pedicle vein, and the venous anastomosis pattern was end to end to the single internal mammary vein (IMV) (type I, N = 25). However, the other nine flaps were drained by one pedicle vein anastomosed end to end to double IMV (type II, N = 2), end to end to both proximal and distal ends of single IMV (type III, N = 5), end to end and end to side to single IMV (type IV, N = 2), and end to end to single IMV without anastomosing the other (type V, N = 1). All flaps were successful, except in one patient with type I anastomosis who received vascular reexploration due to pedicle twisting. Another patient with type I anastomosis needed revision due to partial fat necrosis of the flap. No other complications were found. Various modifications of internal mammary vessel anastomosis can be used to ensure the safety of deep inferior epigastric perforator flap in breast reconstruction.

Free Groin Flap Applications in the Pediatric Population

The popularity of the groin flap has gradually decreased because of the disadvantages related to its short pedicle and technically demanding harvesting. We have summarized our experience with free groin flap applications in the pediatric population, which were performed by the same surgeon between 2004 and 2007. A total of 10 free groin flap transfers were performed in patients aged 3 to 13 years. Nine of the patients were operated on because of contractures of the extremities (six lower, three upper), and one patient was operated on for facial contour augmentation. The total duration of the operation was estimated to be between 2.6 and 6.1 hours (mean: 4.1 hours). A revision of the anastomosis was performed in two patients (20%), and in one of these patients (50%) partial flap failure was seen. Flap defatting via liposuction was performed in four patients (40%) in the late postoperative period. In our opinion, donor site morbidity comes into prominence particularly in the pediatric population, and we think that free groin flap should be the first choice of free flap for suitable cases in this group of patients.

Biomechanical Analysis Comparing Three C1–C2 Transarticular Screw Salvaging Fixation Techniques

This is an in vitro biomechanical study. To compare the biomechanical stability of the 3 C1-C2 transarticular screw salvaging fixation techniques. Stabilization of the atlantoaxial complex is a challenging procedure because of its complicated anatomy. Many posterior stabilization techniques of the atlantoaxial complex have been developed with C1-C2 transarticular screw fixation been the current gold standard. The drawback of using the transarticular screws is that it has a potential risk of vertebral artery injury due to a high riding transverse foramen of C2 vertebra, and screw malposition. In such cases, it is not recommended to proceed with inserting the contralateral transarticular screw and the surgeon should find an alternative to fix the contralateral side. Many studies are available comparing different atlantoaxial stabilization techniques, but none of them compared the techniques to fix the contralateral side while using the transarticular screw on one side. The current options are C1 lateral mass screw and short C2 pedicle screw or C1 lateral mass screw and C2 intralaminar screw, or C1-C2 sublaminar wire. Nine fresh human cervical spines with intact ligaments (C0-C4) were subjected to pure moments in the 6 loading directions. The resulting spatial orientations of the vertebrae were recorded using an Optotrak 3-dimensional Motion Measurement System. Measurements were made sequentially for the intact spine after creating type II odontoid fracture and after stabilization with unilateral transarticular screw placement across C1-C2 (TS) supplemented with 1 of the 3 transarticular salvaging techniques on the contralateral side; C1 lateral mass screw and C2 pedicle screw (TS+C1LMS+C2PS), C1 lateral mass and C2 intralaminar screw (TS+C1LMS+C2ILS), or sublaminar wire (TS + wire). The data indicated that all the 3 stabilization techniques significantly decreased motion when compared to intact in all the loading cases (left/right lateral bending, left/right axial rotation, flexion) except extension. All the 3 instrumented specimens were equally stable in extension/flexion and lateral bending modes. TS+C1LMS+C2PS was equivalent to TS+C1LMS+C2ILS (P > 0.05) and superior to TS + wire in axial rotation (P < 0.05). Also, TS+C1LMS+C2ILS was superior to TS + wire in axial rotation (P < 0.05). Fixation of atlantoaxial complex using unilateral transarticular screw supplemented with contralateral C1 lateral mass and C2 intralaminar screws is biomechanically equivalent to C1 lateral mass and C2 pedicle screws and both are biomechanically superior to C1-C2 sublaminar wire in axial rotation.

The evaluation of short fusion in idiopathic scoliosis

Background:Selective thoracic fusion in type II curve has been recommended by King et al. since 1983. They suggested that care must be taken to use the vertebra that is neutral and stable so that the lower level of fusion is centered over the sacrum. Since then there has been the trend to do shorter and selective fusion of the major curve. This study was conducted to find out whether short posterior pedicle instrumentation alone could provide efficient correction and maintain trunk balance comparing to the anterior instrumentation.Materials and Methods:A prospective study was conducted during 2005-2007 on 39 consecutive cases with idiopathic scoliosis cases King 2 and 3 (Lenke 1A, 1B), 5C and miscellaneous. Only the major curve was instrumented unless both curves were equally rigid and of the same magnitude. The level of fusion was planned as the end vertebra (EVB) to EVB fusion, although minor adjustment was modified by the surgeons intraoperatively. The most common fusion levels in major thoracic curves were T6–T12, whereas the most common fusion levels in the thoraco-lumbar curves were T10–L3. Fusion was performed from the posterior only approach and the implants utilized were uniformly plate and pedicle screw system. All the patients were followed at least 2 years till skeletal maturity. The correction of the curve were assessed according to type of curve (lenke IA, IB and 5), severity of curve (less than 450, 450-890 and more than 900), age at surgery (14 or less and 15 or more) and number of the segment involved in instrumentation (fusion level less than curve, fusion level as of the curve and fusion more than the curve)Results:The average long-term curve correction for the thoracic was 40.4% in Lenke 1A, 52.2% in Lenke 1B and 56.3% in Lenke 5. The factors associated with poorer outcome were younger age at surgery (<11 years or Risser 0), fusion at wrong levels (shorter than the measured end vertebra) and rigid curve identified by bending study. However, all patients had significant improved trunk balance and coronal hump at the final assessment at maturity. Two patients underwent late extension fusion because of junctional scoliosis.Conclusions:With modern instrumentations, the EVB of the major curve can be used at the end of the instrumentation in most cases of idiopathic scoliosis. In those cases with either severe trunk shift, younger than 11 years old, or extreme rigid curve, an extension of one or more levels might be safer. In particular situations, the concept of centering the lowest vertebra over the sacrum should be adopted.

Treatment of thoracalumbar fractures with posterior short segment peg-stick system plus pedicle screw fixation

Objective To investigate the value of posterior short segment peg-stick system plus pediele screw fixation in treatment of thoracolumbar fractures. Methods There were 38 patients invol-ving fractures at Tn in three patients, at T_(12) in 11, at L_1 in 15 and at L_2 in nine. There were three pa-tients with simple fractures of vertebral compression, 35 with burst fractures, 33 with thoracolumbar frac-tures combined with paraplegia. The patients with simple fracture of vertebral compression were treated by posterior short-segment peg-stick system plus pedicle screw fixation. While the patients with paraplegia and intraspinal occupancy were treated by posterior decompression, vertebral enlargement and bone graft-ing (between zygopophysis and transverse process) after fixation. Results All patients received a fol-low-up for average 14.5 months, which showed accurate position of pedicle screw and fine contour of the injured vertebra after reduction, with no loosening or breakage of fixators, chronic lumbar pain or loss of the height of fractured vertebra. Of all, 33 patients were accompanied by paresis. There was one patient at Grade A, six at Grade B, 16 at Grade C and nine at Grade D before operation. But there was one pa-tient at Grade A, one at Grade B, five at Grade C, 10 at Grade D and 16 at Grade E. Conclusions For thoracolumbar fractures especially vertebral burst fractures, posterior short segment speg-stick system plus pedicle screw fixation is an ideal treatment method, for it has the following advantages: no obvious loss of the height of the vertebra after operation, protection of the intact intervertebral disc under the in-jured vertebra and minor effect on range of motion of the lumbar vertebrae. Key words: Spinal fractures; Thoracic vertebrae; Lumbar vertebrae; Fracture fixation, internal

Clinical experience with the lateral septocutaneous superior gluteal artery perforator flap for autologous breast reconstruction

Superior gluteal artery perforator (SGAP) flaps are a useful adjunct for autologous microvascular breast reconstruction. However, limitations of short pedicle length, complex anatomy, and donor site deformity make it an unpopular choice. Our goals were to define the anatomic characteristics of SGAPs in cadavers, and report preliminary clinical and radiographic results of using the lateral septocutaneous perforating branches of the superior gluteal artery (LSGAP) as the basis for a modified gluteal flap. We performed 12 cadaveric dissections and retrospectively reviewed 12 consecutive breast reconstruction patients with gluteal flaps (19 flaps: 9 LSGAP, 10 traditional SGAP) over a 12-month period. The LSGAP flap was converted to traditional SGAP in 53% of flaps because of dominance of a traditional intramuscular perforator. Preoperative 3D computed tomography angiography (CTA) and cadaveric dissections were used to define anatomy. Anatomic, demographic, radiographic, perioperative, and outcomes data were analyzed. Mean follow-up was 4 +/- 3.4 months (range 4 weeks to 10 months). Compared with the pedicle in the SGAP flap, the mean pedicle length in the LSGAP flap was 1.54 times longer by CTA, 2.05 times longer by cadaver dissection, and 2.36 times longer by intraoperative bilateral measurement. These differences were statistically significant (P < 0.001). Clinically, 100% of the flaps survived. LSGAP flap reconstruction is advantageous, when feasible, because of the septocutaneous pedicle dissection and gain in pedicle length that make microsurgical anastomoses easier without compromising gluteus function.