Superior Gluteal Artery Perforator Flap

ABSTRACT

Perforator flaps have revolutionized the field of reconstructive plastic surgery by allowing novel therapeutic options with minimal functional cost to the patient. Despite initial resistance, perforator flaps are now preferentially accepted as the gold standard in autogenous reconstruction in situations where muscle transfer is not necessary. The superior gluteal artery perforator (SGAP) flap constitutes the descendant of the gluteus maximus myocutaneous flap. Although possessing all of its predecessor's advantages, the SGAP flap generates much less donor-site morbidity. Indications for use are multiple, spanning locoregional use as a pedicled flap to free-tissue transfer in breast reconstruction. In this article, we will review the technique of flap harvest with emphasis on some useful tips to achieve an optimal outcome. Typical indications for the flap will be illustrated and specific advantages/disadvantages will be discussed.

SGAP - perforator flap - superior gluteal artery - breast reconstruction - pressure sore

REFERENCES

• 1 Fujino T, Harasina T, Aoyagi F. Reconstruction for aplasia of the breast and pectoral region by microvascular transfer of a free flap from the buttock.  Plast Reconstr Surg. 1975;  56 178-181
• 2 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
• 3 Allen R J, Tucker Jr C. Superior gluteal artery perforator free flap for breast reconstruction.  Plast Reconstr Surg. 1995;  95 1207-1212
• 4 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
• 5 Verpaele A M, Blondeel P N, Van Landuyt K et al.. The superior gluteal artery perforator flap: an additional tool in the treatment of sacral pressure sores.  Br J Plast Surg. 1999;  52 385-391
• 6 Blondeel P N, Beyens G, Verhaeghe R et al.. Doppler flowmetry in the planning of perforator flaps.  Br J Plast Surg. 1998;  51 202-209
• 7 Allen R J. The superior gluteal artery perforator flap.  Clin Plast Surg. 1998;  25 293-302
• 8 Feller A M, Richter-Heine I, Rudolf K D. The superior gluteal artery perforator flap (S-GAP-flap) [in German].  Handchir Mikrochir Plast Chir. 2002;  34 257-261
• 9 Blondeel P N, Van Landuyt K, Hamdi M, Monstrey S J. Soft tissue reconstruction with the superior gluteal artery perforator flap.  Clin Plast Surg. 2003;  30 371-382
• 10 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
• 11 Allen R J, Heitland A S. Autogenous augmentation mammaplasty with microsurgical tissue transfer.  Plast Reconstr Surg. 2003;  112 91-100
• 12 Guerra A B, Soueid N, Metzinger S E et al.. Simultaneous bilateral breast reconstruction with superior gluteal artery perforator (SGAP) flaps.  Ann Plast Surg. 2004;  53 305-310
• 13 Hamdi M, Blondeel P, Van Landuyt K, Tondu T, Monstrey S. Bilateral autogenous breast reconstruction using perforator free flaps: a single center's experience.  Plast Reconstr Surg. 2004;  114 83-89
• 14 DellaCroce F J, Sullivan S K. Application and refinement of the superior gluteal artery perforator free flap for bilateral simultaneous breast reconstruction.  Plast Reconstr Surg. 2005;  116 97-103
• 15 Hamdi M, Blondeel P, Van Landuyt K, Monstrey S. Algorithm in choosing recipient vessels for perforator free flap in breast reconstruction: the role of the internal mammary perforators.  Br J Plast Surg. 2004;  57 258-265
• 16 Roche N A, Van Landuyt K, Blondeel P N, Matton G, Monstrey S J. The use of pedicled perforator flaps for reconstruction of lumbosacral defects.  Ann Plast Surg. 2000;  45 7-14
• 17 Duffy Jr F J, Weprin B E, Swift D M. A new approach to closure of large lumbosacral myelomeningoceles: the superior gluteal artery perforator flap.  Plast Reconstr Surg. 2004;  114 1864-1868
• 18 Coskunfirat O K, Ozgentas H E. Gluteal perforator flaps for coverage of pressure sores at various locations.  Plast Reconstr Surg. 2004;  113 2012-2017
• 19 Higgins J P, Orlando G S, Blondeel P N. Ischial pressure sore reconstruction using an inferior gluteal artery perforator (IGAP) flap.  Br J Plast Surg. 2002;  55 83-85
• 20 Ishida L H, Munhoz A M, Montag E et al.. Tensor fasciae latae perforator flap: minimizing donor-site morbidity in the treatment of trochanteric pressure sores.  Plast Reconstr Surg. 2005;  116 1346-1352
• 21 Blondeel N, Vanderstraeten G G, Monstrey S J et al.. The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction.  Br J Plast Surg. 1997;  50 322-330
• 22 Blondeel P N. One hundred free DIEP flap breast reconstructions: a personal experience.  Br J Plast Surg. 1999;  52 104-111
• 23 Gurunluoglu R, Spanio S, Rainer C, Ninkovic M. Skin expansion before breast reconstruction with the superior gluteal artery perforator flap improves aesthetic outcome.  Ann Plast Surg. 2003;  50 475-479