Superior Gluteal Artery Perforator Flap Research Articles

A Guide to Perforator Flap Selection for Buttock Pressure Sore Reconstruction.

Perforator flaps have been increasingly used to repair stage IV buttock pressure ulcers. However, no one has proposed an approach for stage IV buttock pressure ulcers repairing based on the subregion of buttock pressure ulcers. This study aims to evaluate the effect of perforator flaps in the repair of stage IV buttock pressure ulcers, and flap selection was based on the location of the pressure ulcers. Over the past 5 years, we evaluated 65 cases of stage IV buttock pressure ulcers repaired using perforator flaps. Flap selection was based on the subregion of each buttock pressure ulcer, following our approach. A total of 87 perforator flaps were used for 65 cases, including 42 superior gluteal artery perforator flaps, 19 fourth lumbar artery perforator flaps, and 26 descending inferior gluteal artery perforator flaps. All patients showed satisfactory reconstruction. The authors' approach can support surgeons in selecting the appropriate flaps to repair stage IV buttock pressure ulcers and achieve excellent reconstructive outcomes. This method makes the selection of flaps for pressure ulcer repair systematic, simple, and highly feasible and thus is worthy of promotion.

Safety and Efficacy of the Superior Gluteal Artery Perforator (SGAP) Flap In Autologous Breast Reconstruction: Systematic Review and Metanalysis

Introduction: The superior gluteal artery perforator (SGAP) flap is a valuable technique for autologous breast reconstruction and provides a good alternative to the deep inferior epigastric artery perforator (DIEP) flap, especially in patients with unsuitable lower abdominal tissue. Unlike more commonly used techniques current literature on the outcomes and complications of the SGAP flap is relatively heterogenous and limited. Materials and Methods: A systematic literature search of multiple databases was performed by two independent reviewers using the PRISMA guidelines. We included articles evaluating SGAP flaps in autologous breast reconstruction. Patient’s and flap-related data, flap-related outcomes and complications and donor-site morbidity were recorded and analyzed. Proportions and their 95% confidence intervals (CIs) were calculated in a random-effects meta-analysis. Results: Fifteen studies meeting the inclusion criteria representing a total of 673 SGAP flaps were included. Total flap loss rate was 2% (95% CI 1), partial flap loss rate was 3% (95% CI 0), hematoma rate was 5% (95% CI 2), emergent operative take-back was 7% (95% CI 7) and overall donor-site complications was 12% (95% CI 4). Conclusion: This study is the first systematic review evaluating the efficacy and safety of the SGAP flap in autologous breast reconstruction. It confirms the overall safety and low complication rate of the SGAP flap in breast reconstruction.

Comparison of Lumbar Artery and Superior Gluteal Artery Perforator Flaps for Breast Reconstruction: Multislice CT-Based Anatomical Study.

Although the deep inferior epigastric artery perforator flap is the criterion standard for autologous breast reconstruction, lumbar artery perforator (LAP) and superior gluteal artery perforator (SGAP) flaps are recent trends as alternatives. The purpose of our study was to clarify differences of these flaps based on multislice CT findings of the same patient. Retrospective study was conducted on 58 patients who underwent preoperative contrast-enhanced multislice CT for breast reconstruction using deep inferior epigastric artery perforator. Of these, 32 patients' data were evaluated excluding 26 patients' data either for the lumbar or gluteal fat being outside the imaging range or for nondepiction of the vascular pedicle origin of LAP or SGAP flap. Vascular pedicle diameter, pedicle length, and subcutaneous fat thickness were measured for LAP and SGAP flaps. The vascular pedicle diameter, pedicle length, and fat thickness were 2.1 (SD, 0.3) mm, 3.4 (SD, 0.4) cm, and 4.9 (SD, 1.0) cm, respectively, for LAP flaps; and 1.7 (SD, 0.2) mm, 5.6 (SD, 1.1) cm, and 2.7 (SD, 0.7) cm, respectively, for SGAP flaps. The LAP flaps had thicker subcutaneous fat and a larger vascular pedicle diameter, whereas the SGAP flaps had a longer vascular pedicle. As donor material for breast reconstruction, the LAP flap is indicated for cases where absolute volume is needed; otherwise, the SGAP flap is more advantageous as it facilitates vascular anastomosis with its longer vascular pedicle.

Safety and Efficacy of the Superior Gluteal Artery Perforator (SGAP) Flap in Autologous Breast Reconstruction: Systematic Review and Meta-Analysis

(1) Background: The superior gluteal artery perforator (SGAP) flap is a prominent technique for autologous breast reconstruction. Unlike other commonly used techniques, current literature on the safety and efficacy of the SGAP flap is heterogenous and limited. The aim of this article was to perform a systematic literature review and meta-analysis of postoperative outcomes and complications associated with SGAP flap autologous breast reconstructions. (2) Methods: A systematic literature search of multiple databases was performed using the PRISMA guidelines. We included articles evaluating SGAP flaps in autologous breast reconstruction. Outcomes and complications were recorded and analyzed. Proportions and their 95% confidence intervals (CIs) were calculated in a random-effects meta-analysis. (3) Results: Fourteen studies meeting inclusion criteria, representing a total of 667 SGAP flaps, were included. The total flap loss rate was 1% (95% CI 0-3%), partial flap loss rate was 1% (95% CI 0-3%), hematoma rate was 3% (95% CI 1-6%), emergent surgical re-exploration rate was 5% (95% CI 2-9%), and overall donor-site complications were 12% (95% CI 4-23%). (4) Conclusions: This systematic review and meta-analysis provide comprehensive knowledge on the efficacy and safety of the SGAP flap in autologous breast reconstruction. It demonstrates its overall safety and low complication rate, validating its important role as an effective option in breast reconstruction.

Multidisciplinary Treatment of Persistent Nontuberculous Mycobacterial Spinal Hardware Infection with a Pedicled Superior Gluteal Artery Perforator Flap.

Nontuberculous mycobacterial hardware infections are extremely challenging to treat. Multidisciplinary care involving removal of infected hardware, thorough debridement, and durable soft tissue coverage in conjunction with antibiotic therapy is essential for successful management. This case report presents a patient with chronic mycobacterial spinal hardware infection that underwent successful treatment with aggressive serial debridements and reconstruction with a large pedicled superior gluteal artery perforator flap coverage.

Does it Always have to be the Abdomen? Alternative Flaps in Autologous Breast Reconstruction

[English] Deep inferior epigastric artery perforator (DIEP) or muscle-sparing transverse rectus abdominis muscle (ms-TRAM) flaps remain the gold standard for autologous reconstruction in post-mastectomy patients, although many women may not be candidates for abdominally based free tissue transfer. In this scenario, there are several other donor site options based from the thigh (transverse and diagonal upper gracilis flaps, profunda artery perforator flap, lateral thigh flap), trunk (lumbar artery perforator flap), and buttock (superior and inferior gluteal artery perforator flaps). This article will provide insight into the history, relevant anatomy, surgical technique and novel applications (neurotization) for alternative flaps in autologous breast reconstruction.

Comparing Seroma Formation at the Deep Inferior Epigastric Perforator, Transverse Musculocutaneous Gracilis, and Superior Gluteal Artery Perforator Flap Donor Sites after Microsurgical Breast Reconstruction.

Background Seroma formation is the most common donor site complication following autologous breast reconstruction, along with hematoma. Seroma may lead to patient discomfort and may prolong hospital stay or delay adjuvant treatment. The aim of this study was to compare seroma rates between the deep inferior epigastric perforator (DIEP), transverse musculocutaneous gracilis (TMG), and superior gluteal artery perforator (SGAP) donor sites. Methods The authors conducted a retrospective single-center cohort study consisting of chart review of all patients who underwent microsurgical breast reconstruction from April 2018 to June 2020. The primary outcome studied was frequency of seroma formation at the different donor sites. The secondary outcome evaluated potential prognostic properties associated with seroma formation. Third, the number of donor site seroma evacuations was compared between the three donor sites. Results Overall, 242 breast reconstructions were performed in 189 patients. Demographic data were found statistically comparable between the three flap cohorts, except for body mass index (BMI). Frequency of seroma formation was highest at the SGAP donor site (75.0%), followed by the TMG (65.0%), and DIEP (28.6%) donor sites. No association was found between seroma formation and BMI, age at surgery, smoking status, diabetes mellitus, neoadjuvant chemotherapy, or DIEP laterality. The mean number of seroma evacuations was significantly higher in the SGAP and the TMG group compared with the DIEP group. Conclusion This study provides a single center's experience regarding seroma formation at the donor site after microsurgical breast reconstruction. The observed rate of donor site seroma formation was comparably high, especially in the TMG and SGAP group, necessitating an adaption of the surgical protocol.

A Comparative Study between Excision and Reconstruction Using Superior Gluteal Artery Perforator Flap and Lay Open in Cases of Recurrent Pilonidal Sinuses

A Comparative Study between Excision and Reconstruction Using Superior Gluteal Artery Perforator Flap and Lay Open in Cases of Recurrent Pilonidal Sinuses

A Single Superior Gluteal Artery Perforator Flap in Reconstruction of Large Midline Sacral Defects: A Method for Practical Harvest and Safe Closure.

Large midline sacral defects are reconstructive challenges. Superior gluteal artery perforator (SGAP) flap provides enough tissue and versatility to cover large defects; however, a single flap may be insufficient. We present a technique to cover large defects using single SGAP flaps. Large sacral defects (>100 cm2) reconstructed with single SGAP flaps were included. Angle of transposition (45°-60°) was determined based on the tissue laxity and mobility of gluteal area. Perforator identification, intramuscular dissection, or skeletonization was not performed. Outcomes were measured as achieving durable reconstruction, flap viability, and complications. There were 17 patients (12 male, 5 females; aged 25-72 years) with different etiologies. The mean flap surface area (136.1 ± 45.6 cm2, between 9 × 8 and 26 × 10 cm) was smaller than the mean defect surface area (211.1 ± 87.2 cm2, between 10 × 10 and 28 × 14 cm) (P < 0.001). All flaps survived with no partial or complete flap loss. Minor dehiscence in 4 patients (2 at donor site and 2 at recipient site) healed with dressing changes or using negative-pressure vacuum therapy. All patients had durable outcomes without any recurrence. Single unilateral SGAP flaps can be used to completely cover midline large sacral defects. It is important to design the flaps to have a joint side with the defect in the proximal part and use the intrinsic mobility of gluteal soft tissues for the closure. Flaps can be (1) planned to be smaller than the defects, (2) harvested with no intramuscular perforator dissection or pedicle skeletonization, and (3) transposed with an angle less than 60°.

Comparison of Detection of Superior Gluteal Artery Perforator by Indocyanine Green Fluorescence Near-Infrared ANGIOGRAPHY and Handheld Acoustic Doppler Sonography for Reconstruction of Sacral Pressure Injury.

Aims: Pressure injury is a gradually increasing disease in the aging society. The reconstruction of a pressure ulcer requires a patient and surgical technique. The patients were exposed to the radiation risk under other ways of detection of perforators such as computed tomographic angiography and magnetic resonance angiography. Here, we compared two radiation-free methods of a superior gluteal artery perforator (SGAP), flap harvesting and anchoring. One is the traditional method of detecting only handheld acoustic Doppler sonography (ADS) (Group 1). The other involves the assistance of intraoperative indocyanine green fluorescent near-infrared angiography (ICGFA) and handheld ADS (Group 2). Materials and Methods: This is a single-center, retrospective, observational study that included patients with sacral pressure injury grades III and IV, who had undergone reconstructive surgery with an SGAP flap between January 2019 and January 2021. Two detection methods were used intraoperatively. The main outcome measures included the operative time, estimated blood loss, major perforator detection numbers, wound condition, and incidence of complications. Results: Sixteen patients underwent an SGAP flap reconstruction. All patients were diagnosed with grade III to IV sacral pressure injury after a series of examinations. Group 1 included 8 patients with a mean operative time of 91 min, and the mean estimated blood loss was 50 mL. The mean number of perforators was 4. Postoperative complications included one wound infection in one case and wound edge dehiscence in one case. No mortality was associated with this procedure. The mean total hospital stay was 16 days. Group 2 included 8 patients with a mean operative time of 107.5 min, and the mean estimated blood loss was 50 mL. The mean number of perforators was 5. Postoperative complications included one wound infection. No mortality was associated with this procedure. The mean total hospital stay was 13 days. Conclusions: The combination of detection of the SGAP by ICGFA and handheld ADS for the reconstruction of a sacral pressure injury provides a more accurate method and provides the advantage of being radiation-free.

Outcome of Closure of Wide Based Defects by Various Rotational Flaps

Aim: To observe the outcome of closure of wide based defects by various rotational flaps for meningomyelocele defects. Study setting: Neurosurgery Department, Sheikh Zayed Hospital, Rahim yar khan Duration: From Oct 2018 to Oct 2020, Methodology: We included 15 patients with wide based myelomeningocele anomalies in the neurosurgery department, Sheikh Zayed Hospital, Rahim yar khan. Age ranged from four days to eight years. The flaw had a diameter of between 8x5cm and 12x8cm. Rotational flaps were used to restore soft tissue defects in all cases. Result: In this study, we did posterior intercostal artery perforator flap(superiorly based) in 40% patients, double rotation flap (yin yang) in 26.7% patients, superior gluteal artery perforator flap in 20 % patients and z plasty in 13.3 % patients. Regarding complications, 2 (13.3%) individuals had a superficial wound dehiscence. One individual (6.7%) developed necrosis of the distal portion of the flap, which was conventionally handled. Postoperatively, no neurosurgical problem occurred. After an average of 6 months, no patient experienced reappearance or dural sac herniation. Conclusion: Restoration of large meningomyelocele defects using local rotational flaps is a secure and reliable approach for abnormalities in the lumbosacral region. Keywords: Meningomyelocele, rotational flaps

Unique hybrid double apposing flap in a Z-plasty technique to reconstruct major perianal defect resulting from chondyloma acuminatum resection - Case report.

Perianal area is anatomically challenging location to reconstruct after wide extensive local excision especially when preserving the anus anatomy anal sphincter continence is a requirement. That is the case in many benign locally aggressive conditions, due to high risk of suture line disruption, wound dehiscence, and wound infection. Many surgical options like primary closure, loco reginal flaps, distant or pedicled flaps, or even free flaps are available for such reconstruction. This is a report of a case of locally aggressive infection that was initially confused as complex perianal fistula, then sarcoma after the initial resection. Surprisingly, the permanent pathology confirmed the diagnosis of a giant condyloma acuminatum extending to the anal area, for which an extensive wide local resection with margin and temporary colostomy was done, this resulted in a large defect necessitating a reconstruction with hybrid double apposing Superior gluteal artery perforator flap (SGAP flap) and Inferior gluteal artery perforator flap (IGAP flap) in Z-plasty fashion. That healed completely with no local complication.

Reconstruction of lumbosacral defect with pedicled superior gluteal artery perforator flap: A case report and literature review

Lumbosacral defect after instrumented spinal fusion is a serious complication that challenges orthopedic surgeons. We report a case of a 63-year-old woman who underwent instrumented thoracolumbosacral correction and reconstruction surgery. Deep operative wound infection and dehiscence occurred. The wound cultures yielded Staphylococcus aureus, which was sensitive to oxacillin. After extensive debridement and negative pressure vacuum-assisted closure therapy, the soft tissue reconstruction team of our department was consulted for her irreparable lumbosacral wound defect with partial implant exposure. A pedicled superior gluteal artery perforator flap was used as a salvage procedure for lumbosacral soft tissue reconstruction. She was satisfied with the surgical results and returned to her daily activities with good recovery.

Staged repair strategy for chronic sacrococcygeal radiation ulcer

Objective: To investigate the clinical effect of staged repair strategy for chronic sacrococcygeal radiation ulcer. Methods: The retrospective cohort study method was applied. Twelve patients with chronic sacrococcygeal radiation ulcer were admitted to Beijing Jishuitan Hospital from January 2010 to June 2020, including 7 males and 5 females, aged 38-74 years. The thorough debridement was performed in the first stage, with wounds area after debridement ranging from 8 cm×6 cm to 22 cm×14 cm, and continuous vacuum sealing drainage (VSD) was performed after the debridement operation. In the second stage, personalized surgery scheme was formulated according to the patient's age, systemic condition, vascular condition, and the position, size, and depth of wound. Six cases were reconstructed with superior/inferior gluteal artery perforator flaps, 4 cases were repaired with gluteus maximus myocutaneous flaps, 1 case was repaired with pedicled latissimus dorsi myocutaneous flap, and 1 case was reconstructed with free transplantation of latissimus dorsi myocutaneous flap. The area of flaps or myocutaneous flaps ranged from 10 cm×8 cm to 25 cm×18 cm. Donor sites of the flaps were sutured primarily in 9 patients and in the other 3 patients were repaired with intermediate split-thickness skin graft in back. The survival of flap or myocutaneous flap after operation, recurrence of tumor, and the appearance and texture of flap or myocutaneous flap, and wound healing were observed during follow-up. Results: Flaps or myocutaneous flaps in 11 patients survived after operation, and superior gluteal artery perforator flap in 1 patient had partial distal necrosis, which was covered again with flap pushed to the distal after debridement and resection of the necrotic tissue. The wounds in 8 patients achieved primary healing, 1 patient repaired with superior gluteal artery perforator flap experienced subcutaneous infection, 1 patient repaired with superior gluteal artery perforator flap suffered distal venous congestion of the flap, and 1 patient repaired with gluteus maximus myocutaneous flap had hematoma under myocutaneous flap, and 1 patient repaired with retrograde latissimus dorsi myocutaneous flap had incision exudation and dehiscence, which were all healed after dressing change, etc. There was no recurrence of tumor after the operation. The wounds healed well during follow-up of 2-52 months after discharge, with no recurrence of infection, and the flaps were soft in texture, with satisfactory appearance and well healed donor sites. Conclusions: On the basis of thorough debridement and VSD in the first stage, superior/inferior gluteal artery perforator flap, gluteus maximus myocutaneous flap, or pedicled/free latissimus dorsi myocutaneous flap with abundant blood supply is applied to repair chronic sacrococcygeal radiation ulcer in the second stage. The staged operation is reliable, with minimal injury to the donor site of flap and satisfactory therapeutic effect.

Dual Reconstruction of Lumbar and Gluteal Defects with Freestyle Propeller Flap and Muscle Flap.

Background:The reconstruction of complex tissue defects in the lumbar and gluteal areas is a surgical challenge. The use of freestyle perforator-based flaps has gained popularity in the reconstruction of these defects due to several advantages: versatility, minimal donor-site morbidity, and tension-free closure. The present study reports the outcome of using a dual coverage of lumbar and gluteal defects with a gluteus maximus rotation flap as a deep layer and a freestyle propeller perforator-based flap as a superficial layer.Methods:A retrospective analysis of 18 patients who had a dual coverage of complex wounds of the lumbar and the gluteal areas was conducted. Different propeller flaps were used as superior gluteal artery perforator flap (SGAP), inferior gluteal artery perforator flap (IGAP), and posterior thigh perforator flap (PTP).Results:The study included 15 men and 3 women. The mean age was 26.3 years. The causes of the defects were: pressure ulcers in 14 patients and post-traumatic in 4 patients. A total of 28 freestyle flaps was used: 11 patients had 1 flap, 4 had 2 flaps, and 3 had 3 flaps. The mean postoperative follow-up was 12.2 months. The complications registered in the medical records were venous congestion in 2 patients, partial flap necrosis in 2 patients, and wound dehiscence in 1 patient.Conclusions:A freestyle propeller perforator-based flap combined with a gluteus maximus muscle flap is a solution that provides well-padding over bony prominence with a low complication rate. However, a long-term follow-up is needed to verify these results.

Alternative flaps in autologous breast reconstruction.

The gold standard for autologous reconstruction in the post-mastectomy patient remains the deep inferior epigastric artery perforator flap, although many women may not be candidates for abdominally based free tissue transfer. In this scenario, there are several other donor site options based from the thigh (transverse and diagonal upper gracilis flaps, profunda artery perforator flap, lateral thigh flap) and trunk (lumbar artery perforator flap, superior and inferior gluteal artery perforator flaps). This study will review the history, relevant anatomy, surgical technique and outcomes for alternative flaps in autologous reconstruction. Additionally, preoperative imaging (CTA, MRA) and novel applications (stacking flaps, neurotization) in breast reconstructive microsurgery will be discussed.

The Effect of Intraoperative Radiotherapy on Healing and Complications After Sacrectomy and Immediate Reconstruction.

Sacropelvic resection is the treatment of choice for pelvic bone tumors and can be associated with intraoperative electron radiotherapy (IOERT) to optimize local control of the disease. Reconstruction with flaps also is essential to avoid pelvic complications. There is scarcity of publications evaluating outcomes of reconstructive procedures associated with IOERT. A prospective study in 53 patients between 2005 and 2018 was performed. Thirty-four patients received IOERT (group I [GI]) and 19 did not (GII). We examined demographic characteristics, tumor pathology, type of resection and volume of surgical specimen, timing of surgery, IOERT doses, postoperative stay, and complications. We used it for reconstruction rectus abdominis, gluteal, omental and gracilis, superior gluteal artery perforator flap, and free flaps. Colonic adenocarcinoma and chordoma were the most frequent tumors. The median (interquartile range) IOERT dose was 1250 (1000-1250) cGy; operating time was 10.15 (8.6-14.0) hours versus 6.0 (5.0-13.0) hours, hospital stay was 37 (21.2-63.0) days versus 26.0 (12.0-60.0) days, and volume of surgical specimen was 480.5 (88.7-1488.0) mL versus 400 (220.0-6700.0) mL in GI and GII, respectively. Operating time was significantly longer in GI (P < 0.03). There were significant positive correlations between operating time, hospital stay, and volume of surgical specimen. Main complications were exudative wounds (50% vs 31.5%), wound dehiscence (41.1% vs 31.5%), and seroma (29.4% vs 26.3%) in GI and GII, respectively. Complications were similar to previous studies with or without radiotherapy. Under a reconstructive approach, IOERT did not harm flap survival nor increased pelvic complications when compared with similar cases without IOERT.

Versatility of Gluteal Arteries Perforator Flaps for Local Coverage Relative to Defect Size, Site, and Different Pathological Conditions

Background: Superior and inferior gluteal artery perforator flaps have evolved in the last few decades for both free and local tissue transfer because of having the advantages of being voluminous with a relatively inconspicuous donor site. Therefore focusing on the details of such a reconstructive procedure would be of importance when thinking of skin defect coverage in the lower back, gluteal, and upper thigh areas. Patients and methods: This study was done on 14 cases, 10 of them had defects due to pressure sores, and 4 cases due to other inflammatory and neoplastic conditions. All cases were done by the same surgical team with a follow up period ranging from 2 to 18 months. Results: Thirteen out fourteen flaps (92%) passed completely and uneventfully with no need for additional surgery throughout eighteen months of follow up. However, two cases developed wound dehiscence that required secondary sutures to one of them, two cases developed seroma, and one case developed partial flap loss which re-advanced by V-Y technique.Conclusion: The superior and inferior gluteal artery perforator flaps are versatile reconstructive coverage option for gluteal defects of different size, site and pathology. They are easy to perform; suitable for large defect reconstruction of the lower back, buttock, and upper thigh areas.

Perianal Circumferential Reconstruction with Tailored Superior Gluteal Artery Perforator Flap

Reconstruction following wide excision of perianal lesion is challenging as it requires resistance to high risks of wound contamination and preservation of anal function. Here, we present a case of a unilateral superior gluteal artery perforator (SGAP) flap with an opening in the flap. A 77-year old woman was referred due to an extramammary Pagets disease encircling the anus. Wide excision was performed by the general surgeon team, which generated a circumferential perianal defect. A unilateral SGAP flap was elevated. Primary defatting was done and an opening was made at the proper location of the anus. The anal mucosa was pulled out through the hole and sutured to the flap. She was discharged without any complications. At the follow-up visit, preservation of postoperative anal functions, as well as satisfactory contour, were observed. A well-tailored unilateral SGAP flap may be a good option for reconstruction of a perianal defect encircling the anus.

VANISHING PLEURAL EFFUSION: DRESSLER-LIKE SYNDROME IN PATIENT WITH FOREIGN BODY REACTION

SESSION TITLE: Fellows Disorders of the Pleura Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: We describe a patient who developed bilateral right greater than left pleural effusions after surgical alteration of her prior silicone breast implants. She had near-complete resolution of her effusion with a course of non-steroidal anti-inflammatory drugs (NSAIDs). CASE PRESENTATION: We describe a 42 y/o lady, former 5.5 pack-year smoker, triple-negative breast cancer in remission, status-post bilateral mastectomy and silicone breast implantation. She since had bilateral breast reconstruction, involving superior gluteal artery perforator (SGAP) flap. She developed dyspnea and pleuritic pain within 2 weeks of her SGAP procedure, and presented to our center. She had stable vitals on admission, and did not require supplemental oxygen; however, her dyspnea and pleuritic pain were affecting her daily activities. Chest X-ray revealed a moderate right and a small left pleural effusion, confirmed on PE protocol CT scan, which was negative for PE. She was initially treated with diuretics which failed to improve her symptoms or pleural effusion size. Right thoracentesis was then performed, yielding 800 mL of serous yellow fluid. Fluid studies were consistent with an exudative effusion, with negative cytology and no bacterial or fungal growth, pH 7.48, LDH 200, glucose 88, total protein 4.1. Immediate post-procedure chest x-ray showed significant improvement in right effusion, and dyspnea was alleviated. Within 24 hours, the effusion on the right re-accumulated to a size equivalent to prior to thoracentesis. She was once again dyspneic. Suspecting an underlying inflammatory process, the patient was started on ibuprofen 600 mg QID. Within 2 days, patient felt symptomatic improvement. Outpatient follow-up chest X-ray 10 days after NSAID initiation was revealing of near-complete resolution of right effusion and symptoms. NSAID taper was then initiated. Repeat chest-XR 1 month after first dose of NSAID’s showed total resolution of pleural effusions. DISCUSSION: Foreign body reaction (FBR), or an inflammatory response to non-native entities such as breast implants, has been described as a cause of systemic release of inflammatory factors [1]. One report describes the development of pleural effusion 6 weeks after silicone breast implants [2]. We postulate the SGAP flap procedure resulted in manipulation of her prior silicone implants, resulting in an FBR. Neither IV diuretics nor therapeutic thoracentesis resulted in lasting resolution of her effusion, making fluid overload less likely. Pleural fluid studies were negative for cancer cells. The marked improvement with NSAIDs suggests an underlying systemic inflammatory response, not unlike Dressler’s Syndrome. CONCLUSIONS: Clinicians should be aware of pleural effusions that are secondary to a foreign body reaction, and consideration of a course of non-steroidal anti-inflammatory drugs should be considered if other causes of effusion have been ruled out. Reference #1: Tralhão, António et al. “The return of a disappearing entity: Dressler's syndrome after transvenous pacemaker implantation.” BMJ case reports vol. 2014 bcr2013203401. 20 Mar. 2014, doi:10.1136/bcr-2013-203401 Reference #2: Silicone Breast Implants: A Rare Cause of Pleural Effusion Shaik, Imam et al. CHEST, Volume 148, Issue 4, 444A DISCLOSURES: no disclosure on file for Alexander Geyer; No relevant relationships by Saamia Hossain, source=Web Response