title: Anatomical basis of the lateral superior gluteal artery perforator (LSGAP) flap and role in bilateral breast reconstruction.
abstract: BACKGROUND
  Deep inferior epigastric perforator (DIEP) flap is one of the gold standards in autologous breast reconstruction. When the abdominal tissue is not available, the superior gluteal artery perforator (SGAP) is often a second option with its drawback, especially the donor-site deformity. Reports have highlighted that a higher and more lateral SGAP flap can be harvested to overcome several drawbacks of the classical SGAP, allowing in the same procedure a body-contouring procedure. In order to set the anatomical basis of this flap, we proposed to study the characteristics of a reliable and easily identifiable superior and lateral perforator of the superior gluteal artery (lateral SGAP (LSGAP)) situated in the region of the lower body-lift resection allowing to perform bilateral breast reconstruction at the same time.
  
  
  METHODS
  The anatomical study of 50 scans (or 100 buttocks) allows us to set forth a diagnostic assumption on the localisation of the perforator with respect to osseous landmarks (coccyx, iliac crest and great trochanter) which will be verified during the dissection of 10 cadavers (or 20 buttocks) and during the 20 colour Doppler examination (or 40 buttocks).
  
  
  RESULTS
  In our computed tomography (CT) scan study, in 96% of cases, the perforator was situated in a circle with a radius≤3 cm with a 95% confidence interval and located at the junction of the proximal third-middle third of the distance summit of the posterior iliac crest (point B), most lateral point of the greater trochanter (point C). This assumption was verified by the cadaveric dissection and in vivo studies.
  
  
  CONCLUSIONS
  Our study sets the anatomical landmarks of the LSGAP flap. This option allows the raising of an SGAP flap avoiding the main drawbacks of this flap and allows harvesting a flap with the tissue that is often discarded during the body-lift procedure.
authors.affiliation: Plastic Reconstructive and Aesthetic Surgery Department, University Hospital of Bordeaux, Bordeaux, France.
authors.forename: Geraldine
authors.initials: G
authors.lastname: Fade
authors.forename: Fabienne
authors.initials: F
authors.lastname: Gobel
authors.forename: Eric
authors.initials: E
authors.lastname: Pele
authors.forename: Benoit
authors.initials: B
authors.lastname: Chaput
authors.forename: Ignacio
authors.initials: I
authors.lastname: Garrido
authors.forename: Vincent
authors.initials: V
authors.lastname: Pinsolle
authors.forename: Philippe
authors.initials: P
authors.lastname: Pelissier
authors.forename: Raphael
authors.initials: R
authors.lastname: Sinna
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000792:Angiography; D001158:Arteries / Q000601:surgery; D001943:Breast Neoplasms / Q000601:surgery*; D002081:Buttocks / Q000098:blood supply* / Q000000981:diagnostic imaging; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D061525:Perforator Flap / Q000601:surgery*; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography