Inferior Gluteal Perforator Flaps for Breast Reconstruction

ABSTRACT

Perforator flaps represent the latest in the evolution of soft tissue flaps. They allow the transfer of the patient's own skin and fat in a reliable manner with minimal donor-site morbidity. The powerful perforator flap concept allows transfer of tissue from numerous, well-described donor sites to almost any distant site with suitable recipient vessels. The inferior gluteal artery perforator (I-GAP) flap is one option that allows a large volume of tissue to be used for breast reconstruction with minimal donor site morbidity. The ideal tissue for breast reconstruction is fat with or without skin, not implants or muscle. Absolute contraindications specific to perforator flaps in our practice include history of previous liposuction of the donor site, some previous donor site surgery, or active smoking (within 1 month prior to surgery). Perforator flaps are supplied by blood vessels that arise from named, axial vessels and perforate through or around overlying muscles and septa to vascularize the overlying skin and fat. The I-GAP flap is based on one or more perforators from the inferior gluteal artery. During flap harvest, these perforators are meticulously dissected free from the surrounding muscle, which is spread in the direction of the muscle fibers and preserved intact. The vascular pedicle is anastomosed to recipient vessels in the chest and the donor site is closed directly. The I-GAP flap provides an excellent option for the safe, reliable tissue transfer from the buttock for breast reconstruction with minimal donor site morbidity.

KEYWORDS

Perforator flap - microsurgery - free flap - I-GAP - breast reconstruction

REFERENCES

• 1 Taylor G I, Daniel R K. The anatomy of f several free flap donor sites.  Plast Reconstr Surg. 1975;  56 243-253
• 2 Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle.  Br J Plast Surg. 1989;  42 645-648
• 3 Allen R J, Treece P. Deep inferior epigastric perforator flap for breast reconstruction.  Ann Plast Surg. 1994;  32 32-38
• 4 Allen R, Tucker Jr C. Superior gluteal artery perforator free flap for breast reconstruction.  Plast Reconstr Surg. 1995;  95 1207-1212
• 5 Le-Quang C. Secondary microsurgical reconstruction of the breast and free inferior gluteal flap.  Ann Chir Plast Esthet. 1992;  37 723-741
• 6 Shaw W W. Breast reconstruction by superior gluteal microvascular free flaps without silicone implants.  Plast Reconstr Surg. 1983;  72 490-501
• 7 Shaw W W. Microvascular free flap breast reconstruction.  Clin Plast Surg. 1984;  11 333-341
• 8 Shaw W W. Superior gluteal free flap breast reconstruction.  Clin Plast Surg. 1998;  25 267-274
• 9 Codner M A, Nahai F. The gluteal artery free flap breast reconstruction. Making it work.  Clin Plast Surg. 1994;  21 289-296
• 10 Paletta C E, Bostwick III J, Nahai F. The inferior gluteal free flap in breast reconstruction.  Plast Reconstr Surg. 1989;  84 875-883
• 11 Guerra A B, Metzinger S E, Bidros R S, Gill P S, Dupin C L, Allen R J. Breast reconstruction with gluteal artery perforator (GAP) flaps: a critical analysis of 142 cases.  Ann Plast Surg. 2004;  52 118-125
• 12 Strauch B, Yu H L. Gluteal region. In Strauch B, Yu HL Atlas of Microvascular Surgery: Anatomy and Operative Approaches. New York; Thieme Medical Publishers 1993: 102-119
• 13 Koshima I, Moriguchi T, Soeda S, Kawata S, Ohta S, Ikeda A. The gluteal perforator-based flap for repair of sacral pressure sores.  Plast Reconstr Surg. 1993;  91 678-683
• 14 Windhofer C, Brenner E, Moriggl B, Papp C. Relationship between the descending branch of the inferior gluteal artery and the posterior femoral cutaneous nerve applicable to flap surgery.  Surg Radiol Anat. 2002;  24 253-257
• 15 Blondeel P N. The Sensate free superior gluteal artery perforator (S-GAP) flap: a valuable alternative in autologous breast reconstruction.  Br J Plast Surg. 1999;  52 185-193
• 16 Boustred A M, Nahai F. Inferior gluteal free flap breast reconstruction.  Clin Plast Surg. 1998;  25 275-282