title: Clinical experience with the lateral septocutaneous superior gluteal artery perforator flap for autologous breast reconstruction.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Plastic, Reconstructive, and Maxillofacial Surgery, Department of Surgery, The Johns Hopkins University, Baltimore, MD 21287, USA.
authors.forename: Ariel N
authors.initials: AN
authors.lastname: Rad
authors.forename: Jaime I
authors.initials: JI
authors.lastname: Flores
authors.forename: Roni B
authors.initials: RB
authors.lastname: Prucz
authors.forename: Sahael M
authors.initials: SM
authors.lastname: Stapleton
authors.forename: Gedge D
authors.initials: GD
authors.lastname: Rosson
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery; D002081:Buttocks / Q000098:blood supply; D002102:Cadaver; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome