Modification of the superior gluteal artery perforator flap for reconstruction of sacral sores

Chin-Ta Lin, Shun-Cheng Chang, Shyi-Gen Chen, Yuan-Sheng Tzeng

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Despite advances in reconstruction techniques, the treatment of sacral sores remains challenging to plastic surgeons. The superior gluteal artery perforator (SGAP) flap is reliable and preserves the entire contralateral side as a future donor site. The ipsilateral gluteal muscle is preserved, and the inferior gluteal artery flaps are viable. However, dissection of the perforator is tedious and may compromise the perforator vessels. Methods: Between April 2003 and March 2013, we performed two modified flap-harvesting techniques: a rotational and a tunnel method, with only a short pedicle dissection to cover 30 sacral defects. Patient characteristics including sex, age, cause of sacral defect, flap size, perforator number, use and postoperative complications were recorded. Results: All flaps survived except two, which developed partial flap necrosis and were finally treated by contralateral V-Y advancement flap coverage. The mean follow-up period was 14.8 months (range, 3-24 months). No flap surgery-related mortality or recurrence of sacral pressure sores or infected pilonidal cysts were noted. Conclusions: Perforator-based flaps have become popular in modern reconstructive surgery because of low donor-site morbidity and good preservation of muscle. The advantages of our modification procedure include shorter operative time, lesser bleeding and lesser pedicle trauma, which make the SGAP flaps an excellent choice for sacral sore coverage. © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
Original languageEnglish
Pages (from-to)526-532
Number of pages7
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
Volume67
Issue number4
DOIs
Publication statusPublished - 2014
Externally publishedYes

Fingerprint

Perforator Flap
Arteries
Dissection
Reconstructive Surgical Procedures
Tissue Donors
Pilonidal Sinus
Muscles
Pressure Ulcer
Operative Time
Esthetics
Sex Characteristics
Plastics
Necrosis
Hemorrhage
Morbidity
Recurrence
Mortality
Wounds and Injuries
Surgeons

Keywords

  • Reconstruction
  • Sacral sore
  • Superior gluteal artery perforator flap
  • adult
  • aged
  • article
  • bleeding
  • clinical article
  • debridement
  • decubitus
  • female
  • gluteus maximus muscle
  • graft necrosis
  • human
  • ipsilateral gluteal muscle
  • island flap
  • male
  • middle aged
  • operation duration
  • plastic surgery
  • priority journal
  • sacrum pressure sore
  • superior gluteal artery perforator flap
  • surgical technique
  • very elderly
  • wound healing
  • young adult
  • Adult
  • Aged
  • Aged, 80 and over
  • Buttocks
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pressure Ulcer
  • Reconstructive Surgical Procedures
  • Surgical Flaps
  • Young Adult

Cite this

Modification of the superior gluteal artery perforator flap for reconstruction of sacral sores. / Lin, Chin-Ta; Chang, Shun-Cheng; Chen, Shyi-Gen; Tzeng, Yuan-Sheng.

In: Journal of Plastic, Reconstructive and Aesthetic Surgery, Vol. 67, No. 4, 2014, p. 526-532.

Research output: Contribution to journalArticle

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abstract = "Background: Despite advances in reconstruction techniques, the treatment of sacral sores remains challenging to plastic surgeons. The superior gluteal artery perforator (SGAP) flap is reliable and preserves the entire contralateral side as a future donor site. The ipsilateral gluteal muscle is preserved, and the inferior gluteal artery flaps are viable. However, dissection of the perforator is tedious and may compromise the perforator vessels. Methods: Between April 2003 and March 2013, we performed two modified flap-harvesting techniques: a rotational and a tunnel method, with only a short pedicle dissection to cover 30 sacral defects. Patient characteristics including sex, age, cause of sacral defect, flap size, perforator number, use and postoperative complications were recorded. Results: All flaps survived except two, which developed partial flap necrosis and were finally treated by contralateral V-Y advancement flap coverage. The mean follow-up period was 14.8 months (range, 3-24 months). No flap surgery-related mortality or recurrence of sacral pressure sores or infected pilonidal cysts were noted. Conclusions: Perforator-based flaps have become popular in modern reconstructive surgery because of low donor-site morbidity and good preservation of muscle. The advantages of our modification procedure include shorter operative time, lesser bleeding and lesser pedicle trauma, which make the SGAP flaps an excellent choice for sacral sore coverage. {\circledC} 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.",
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author = "Chin-Ta Lin and Shun-Cheng Chang and Shyi-Gen Chen and Yuan-Sheng Tzeng",
note = "被引用次數:1 Export Date: 21 March 2016 通訊地址: Tzeng, Y.-S.; Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Cheng-Gung Road, Taipei 11490, Taiwan; 電子郵件: m6246kimo@yahoo.com.tw 參考文獻: Minami, R.T., Mills, R., Pardoe, R., Gluteus maximus myocutaneous flaps for repair of pressure sores (1977) Plastic and Reconstructive Surgery, 60 (2), pp. 242-249; Parry, S.W., Mathes, S.J., Bilateral gluteus maximus myocutaneous advancement flaps: Sacral coverage for ambulatory patients (1982) Annals of Plastic Surgery, 8 (6), pp. 443-445. , DOI 10.1097/00000637-198206000-00001; Stevenson, T.R., Pollock, R.A., Rohrich, R.J., VanderKolk, C.A., The gluteus maximus musculocutaneous island flap; refinements in design and application (1987) Plastic and Reconstructive Surgery, 79 (5), pp. 761-768. , DOI 10.1097/00006534-198705000-00015; Verpaele, A.M., Blondeel, P.N., Van Landuyt, K., Tonnard, P.L., Decordier, B., Monstrey, S.J., Matton, G., The superior gluteal artery perforator flap: An additional tool in the treatment of sacral pressure sores (1999) British Journal of Plastic Surgery, 52 (5), pp. 385-391. , DOI 10.1054/bjps.1999.3101; Koshima, I., Moriguchi, T., Soeda, S., Kawata, S., Ohta, S., Ikeda, A., The gluteal perforator-based flap for repair of sacral pressure sores (1993) Plastic and Reconstructive Surgery, 91 (4), pp. 678-683; Shea, J.D., Pressure sores: Classification and management (1975) Clin Orthop, 112, pp. 89-100; Kierney, P.C., Engrav, L.H., Isik, F.F., Esselman, P.C., Cardenas, D.D., Rand, R.P., Results of 268 pressure sores in 158 patients managed jointly by plastic surgery and rehabilitation medicine (1998) Plastic and Reconstructive Surgery, 102 (3), pp. 765-772; Acarturk, T.O., Parsak, C.K., Sakman, G., Superior gluteal artery perforator flap in the reconstruction of pilonidal sinus (2010) J Plast Reconstr Aesthet Surg, 63, pp. 133-139; Ahmadzadeh, R., Bergeron, L., Tang, M., Morris, S.F., The superior and inferior gluteal artery perforator flaps (2007) Plastic and Reconstructive Surgery, 120 (6), pp. 1551-1556. , DOI 10.1097/01.prs.0000282098.61498.ee, PII 0000653420071100000016; Coskunfirat, O.K., Ozgentas, H.E., Gluteal perforator flaps for coverage of pressure sores at various locations (2004) Plastic and Reconstructive Surgery, 113 (7), pp. 2012-2017. , DOI 10.1097/01.PRS.0000122215.48226.3F; Meltem, C., Esra, C., Hasan, F., Ali, D., The gluteal perforator-based flap in repair of pressure sores (2004) British Journal of Plastic Surgery, 57 (4), pp. 342-347. , DOI 10.1016/j.bjps.2003.12.039; Lee, J.T., Hsiao, H.T., Tung, K.Y., Gluteal perforator flaps for coverage of pressure sores at various locations (2006) Plast Reconstr Surg, 117, pp. 2507-2508; Leow, M., Lim, J., Lim, T.C., The Superior Gluteal Artery Perforator Flap for the Closure of Sacral Sores (2004) Singapore Medical Journal, 45 (1), pp. 37-39; Cheon, Y.W., Lee, M.C., Kim, Y.S., Gluteal artery perforator flap: A viable alternative for sacral radiation ulcer and osteoradionecrosis (2010) J Plast Reconstr Aesthet Surg, 63, pp. 642-647; Hurbungs, A., Ramkalawan, H., Sacral pressure sore reconstruction - The pedicled superior gluteal artery perforator flap (2012) S Afr J Surg, 50, pp. 6-8; Zeng, A., Jia, Y., Wang, X., The superior gluteal artery perforator flap for lumbosacral defect repair: A unified approach (2013) J Plast Reconstr Aesthet Surg, 66, pp. e56-e57; Moon, S.H., Choi, J.Y., Lee, J.H., Feasibility of a deepithelialized superior gluteal artery perforator propeller flap for various lumbosacral defects (2013) Ann Plast Surg, , Oct 21 [Epub ahead of print]",
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TY - JOUR

T1 - Modification of the superior gluteal artery perforator flap for reconstruction of sacral sores

AU - Lin, Chin-Ta

AU - Chang, Shun-Cheng

AU - Chen, Shyi-Gen

AU - Tzeng, Yuan-Sheng

N1 - 被引用次數:1 Export Date: 21 March 2016 通訊地址: Tzeng, Y.-S.; Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Cheng-Gung Road, Taipei 11490, Taiwan; 電子郵件: m6246kimo@yahoo.com.tw 參考文獻: Minami, R.T., Mills, R., Pardoe, R., Gluteus maximus myocutaneous flaps for repair of pressure sores (1977) Plastic and Reconstructive Surgery, 60 (2), pp. 242-249; Parry, S.W., Mathes, S.J., Bilateral gluteus maximus myocutaneous advancement flaps: Sacral coverage for ambulatory patients (1982) Annals of Plastic Surgery, 8 (6), pp. 443-445. , DOI 10.1097/00000637-198206000-00001; Stevenson, T.R., Pollock, R.A., Rohrich, R.J., VanderKolk, C.A., The gluteus maximus musculocutaneous island flap; refinements in design and application (1987) Plastic and Reconstructive Surgery, 79 (5), pp. 761-768. , DOI 10.1097/00006534-198705000-00015; Verpaele, A.M., Blondeel, P.N., Van Landuyt, K., Tonnard, P.L., Decordier, B., Monstrey, S.J., Matton, G., The superior gluteal artery perforator flap: An additional tool in the treatment of sacral pressure sores (1999) British Journal of Plastic Surgery, 52 (5), pp. 385-391. , DOI 10.1054/bjps.1999.3101; Koshima, I., Moriguchi, T., Soeda, S., Kawata, S., Ohta, S., Ikeda, A., The gluteal perforator-based flap for repair of sacral pressure sores (1993) Plastic and Reconstructive Surgery, 91 (4), pp. 678-683; Shea, J.D., Pressure sores: Classification and management (1975) Clin Orthop, 112, pp. 89-100; Kierney, P.C., Engrav, L.H., Isik, F.F., Esselman, P.C., Cardenas, D.D., Rand, R.P., Results of 268 pressure sores in 158 patients managed jointly by plastic surgery and rehabilitation medicine (1998) Plastic and Reconstructive Surgery, 102 (3), pp. 765-772; Acarturk, T.O., Parsak, C.K., Sakman, G., Superior gluteal artery perforator flap in the reconstruction of pilonidal sinus (2010) J Plast Reconstr Aesthet Surg, 63, pp. 133-139; Ahmadzadeh, R., Bergeron, L., Tang, M., Morris, S.F., The superior and inferior gluteal artery perforator flaps (2007) Plastic and Reconstructive Surgery, 120 (6), pp. 1551-1556. , DOI 10.1097/01.prs.0000282098.61498.ee, PII 0000653420071100000016; Coskunfirat, O.K., Ozgentas, H.E., Gluteal perforator flaps for coverage of pressure sores at various locations (2004) Plastic and Reconstructive Surgery, 113 (7), pp. 2012-2017. , DOI 10.1097/01.PRS.0000122215.48226.3F; Meltem, C., Esra, C., Hasan, F., Ali, D., The gluteal perforator-based flap in repair of pressure sores (2004) British Journal of Plastic Surgery, 57 (4), pp. 342-347. , DOI 10.1016/j.bjps.2003.12.039; Lee, J.T., Hsiao, H.T., Tung, K.Y., Gluteal perforator flaps for coverage of pressure sores at various locations (2006) Plast Reconstr Surg, 117, pp. 2507-2508; Leow, M., Lim, J., Lim, T.C., The Superior Gluteal Artery Perforator Flap for the Closure of Sacral Sores (2004) Singapore Medical Journal, 45 (1), pp. 37-39; Cheon, Y.W., Lee, M.C., Kim, Y.S., Gluteal artery perforator flap: A viable alternative for sacral radiation ulcer and osteoradionecrosis (2010) J Plast Reconstr Aesthet Surg, 63, pp. 642-647; Hurbungs, A., Ramkalawan, H., Sacral pressure sore reconstruction - The pedicled superior gluteal artery perforator flap (2012) S Afr J Surg, 50, pp. 6-8; Zeng, A., Jia, Y., Wang, X., The superior gluteal artery perforator flap for lumbosacral defect repair: A unified approach (2013) J Plast Reconstr Aesthet Surg, 66, pp. e56-e57; Moon, S.H., Choi, J.Y., Lee, J.H., Feasibility of a deepithelialized superior gluteal artery perforator propeller flap for various lumbosacral defects (2013) Ann Plast Surg, , Oct 21 [Epub ahead of print]

PY - 2014

Y1 - 2014

N2 - Background: Despite advances in reconstruction techniques, the treatment of sacral sores remains challenging to plastic surgeons. The superior gluteal artery perforator (SGAP) flap is reliable and preserves the entire contralateral side as a future donor site. The ipsilateral gluteal muscle is preserved, and the inferior gluteal artery flaps are viable. However, dissection of the perforator is tedious and may compromise the perforator vessels. Methods: Between April 2003 and March 2013, we performed two modified flap-harvesting techniques: a rotational and a tunnel method, with only a short pedicle dissection to cover 30 sacral defects. Patient characteristics including sex, age, cause of sacral defect, flap size, perforator number, use and postoperative complications were recorded. Results: All flaps survived except two, which developed partial flap necrosis and were finally treated by contralateral V-Y advancement flap coverage. The mean follow-up period was 14.8 months (range, 3-24 months). No flap surgery-related mortality or recurrence of sacral pressure sores or infected pilonidal cysts were noted. Conclusions: Perforator-based flaps have become popular in modern reconstructive surgery because of low donor-site morbidity and good preservation of muscle. The advantages of our modification procedure include shorter operative time, lesser bleeding and lesser pedicle trauma, which make the SGAP flaps an excellent choice for sacral sore coverage. © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

AB - Background: Despite advances in reconstruction techniques, the treatment of sacral sores remains challenging to plastic surgeons. The superior gluteal artery perforator (SGAP) flap is reliable and preserves the entire contralateral side as a future donor site. The ipsilateral gluteal muscle is preserved, and the inferior gluteal artery flaps are viable. However, dissection of the perforator is tedious and may compromise the perforator vessels. Methods: Between April 2003 and March 2013, we performed two modified flap-harvesting techniques: a rotational and a tunnel method, with only a short pedicle dissection to cover 30 sacral defects. Patient characteristics including sex, age, cause of sacral defect, flap size, perforator number, use and postoperative complications were recorded. Results: All flaps survived except two, which developed partial flap necrosis and were finally treated by contralateral V-Y advancement flap coverage. The mean follow-up period was 14.8 months (range, 3-24 months). No flap surgery-related mortality or recurrence of sacral pressure sores or infected pilonidal cysts were noted. Conclusions: Perforator-based flaps have become popular in modern reconstructive surgery because of low donor-site morbidity and good preservation of muscle. The advantages of our modification procedure include shorter operative time, lesser bleeding and lesser pedicle trauma, which make the SGAP flaps an excellent choice for sacral sore coverage. © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

KW - Reconstruction

KW - Sacral sore

KW - Superior gluteal artery perforator flap

KW - adult

KW - aged

KW - article

KW - bleeding

KW - clinical article

KW - debridement

KW - decubitus

KW - female

KW - gluteus maximus muscle

KW - graft necrosis

KW - human

KW - ipsilateral gluteal muscle

KW - island flap

KW - male

KW - middle aged

KW - operation duration

KW - plastic surgery

KW - priority journal

KW - sacrum pressure sore

KW - superior gluteal artery perforator flap

KW - surgical technique

KW - very elderly

KW - wound healing

KW - young adult

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Buttocks

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Pressure Ulcer

KW - Reconstructive Surgical Procedures

KW - Surgical Flaps

KW - Young Adult

U2 - 10.1016/j.bjps.2013.12.031

DO - 10.1016/j.bjps.2013.12.031

M3 - Article

VL - 67

SP - 526

EP - 532

JO - Journal of Plastic, Reconstructive and Aesthetic Surgery

JF - Journal of Plastic, Reconstructive and Aesthetic Surgery

SN - 1748-6815

IS - 4

ER -