Lateral superior gluteal artery perforator flap candidate for breast reconstruction
By Sara Freeman, medwireNews Reporter
26 March 2013
J Plast Reconstr Aesthet Surg 2013; Advance online publication

medwireNews: Removing a higher area of the buttock than usual for bilateral breast reconstruction could improve the cosmetic outcome of the harvested area, say researchers who have mapped out the anatomical basis for the flap.

"[The] deep inferior epigastric perforator flap is one of the gold standards in autologous breast reconstruction," write Raphael Sinna (University Hospital of Amiens, France) and team in the Journal of Plastic, Reconstructive & Aesthetic Surgery. However, abdominal tissue may not always be available and a second choice is to use a superior gluteal arterial perforator (SGAP) flap.

"Reports have highlighted that a higher and more lateral SGAP can be harvested to overcome several drawbacks of the classical SGAP," they observe, adding that this allows for a body-contouring procedure to be simultaneously performed.

To aid surgeons in performing the new lateral SGAP (LSGAP), the researchers conducted an anatomical study, looking for specific landmarks that might aid with its identification and harvesting.

First the team studied computed tomography (CT) scans from 31 men and 19 women, with a mean age of 65 years. Abdominopelvic angiography images from the 50 participants (100 buttocks) were retrospectively assessed, demonstrating that there was no significant difference between the anatomy of the perforator in men and women.

In 96% of cases, the perforator was situated within a circle with a radius of no more than 3 cm, which was pinpointed by clear osseous landmarks. The perforator was "located at the junction of the proximal third-middle third of the distance summit of the posterior iliac crest [and the] most lateral point of the greater trochanter," the researchers report.

Next the team dissected the gluteal regions of three fresh and seven formalin-preserved cadavers, which verified the CT findings.

"In this study we successively determined the radiological and anatomical landmarks of what we called the LSGAP: an SGAP flap based on the most lateral and most superior perforator arising from the superior gluteal artery," Fade and colleges summarize.

"The potential advantage of this flap would be to shift the SGAP flap harvest zone superiorly and laterally while allowing simultaneous body lift, particularly in women undergoing bilateral breast reconstruction."

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