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Superior Gluteal Artery Perforator Flap Based on Septal Perforators: Preliminary Study

2008; Lippincott Williams & Wilkins; Volume: 122; Issue: 5 Linguagem: Inglês

10.1097/prs.0b013e318186caca

1529-4242

Stefania Tuinder, René R. W. J. van der Hulst, Arno Lataster, Willy Boeckx,

Orthopedic Surgery and Rehabilitation

Sir: The superior gluteal artery perforator flap is known as a local flap when used for large defects in the lumbosacral region and as free flap when used for breast reconstruction.1 Conventionally, its perforators are dissected through the gluteus maximus muscle. In anatomical studies concerning the superior gluteal artery and perforators of the gluteal region, no distinction has been made between septal and musculocutaneous perforators.2,3 Cormack and Lamberty4 have described a superficial branch of the superior gluteal artery subdividing between the gluteus maximus and medius muscle into three branches: a posterior branch, an intermediate branch, and an anterior branch. Terminal branches from the anterior branch may emerge at the superolateral edge of the gluteus maximus muscle to pierce the deep fascia and supply the cutaneous and subcutaneous tissue. We focused our attention on these septal perforators running between the gluteus maximus and the medius muscles. Formalin-fixed cadavers of three adults were used to study the anatomy in six gluteal regions. In addition, color Doppler analysis was performed in 20 gluteal regions of 10 adult volunteers with a MyLab 25 color Doppler with an LA523, 4- to 13-MHz probe (Esaote, Genova, Italy). For the anatomical study, in every corpse, at least one septal perforator passing between the gluteus maximus muscle and the medius muscle was found (range, zero to two for the left side and one to four for the right side). All perforators originated from the anterior branch of the superficial branch of the superior gluteal artery (Table 1).Table 1: Projection of the Distance of Septal Perforators from Line A and Line B on the Skin in Three Corpses and 10 VolunteersFor the color Doppler study, in every volunteer, at least one septal perforator passing between the gluteus maximus muscle and the medius muscle was found (range, one to three for the left side and zero to four for the right side) (Table 1 and Fig. 1).Fig. 1.: Color Doppler imaging of a septal perforator in a volunteer.In both studies, the projections on the skin of the distance of every perforator from the midsagittal line (Fig. 2) and from a line perpendicular to it at the cranial end of the natal cleft were registered.Fig. 2.: Projection of the measured positions of the septal perforators on the skin in an average gluteal region giving an impression of their distribution.The 2003 Gent consensus on perforator flaps clarifies the definition of perforator flaps and underlines that septal perforators are easier to identify and dissect. Consequently, septal perforators, as described above, could make the superior gluteal artery perforator flap technically easier.5 In addition, laterally orientated septal perforators improve the arc of rotation in pedicled flaps and provide a long pedicle in free flaps. We advise preoperatively a color Doppler analysis to identify septal perforators. To include septal perforators, the drawing of the superior gluteal artery perforator flap should be a little higher than conventionally, above line B in Figure 2. Stefania Tuinder, M.D. René Van Der Hulst, M.D., Ph.D. Department of Plastic and Reconstructive Surgery University Hospital Maastricht Arno Lataster, M.Sc. Department of Anatomy and Embryology Maastricht University Willy Boeckx, M.D., Ph.D. Department of Plastic and Reconstructive Surgery University Hospital Maastricht Maastricht, The Netherlands