Ten-year experience of superior gluteal artery perforator flap for reconstruction of sacral defects in tri-service general hospital

Chin-Ta Lin, Niann-Tzyy Dai, Shun-Cheng Chang, Shyi-Gen Chen, Tim-Mo Chen, Hsian-Jenn Wang, Yuan-Sheng Tzeng

Research output: Contribution to journalArticle

Abstract

Background: Despite advances in reconstruction techniques, sacral sores continue to present a challenge to the plastic surgeon. The superior gluteal artery perforator (SGAP) flap is a reliable flap that preserves the entire contralateral side as a future donor site. On the ipsilateral side, the gluteal muscle itself is preserved and all flaps based on the inferior gluteal artery are still possible. However, the dissection of the perforator is tedious and carries a risk of compromising the perforator vessels. Patients and Methods: During the period between April 2003 and March 2013, 30 patients presented to our section with sacral wounds causing by pressure sores or infected pilonidal cysts. Of a total of 30 patients, 13 were female and 17 were male. Their ages ranged from 22 to 92 years old (mean 79.8 years old). Surgical intervention was performed electively with immediate or delayed reconstruction using a SGAP flap. The characteristics of patients' age, and sex, and cause of sacral defect, co-morbidities, wound culture, flap size, perforator number, hospital stay, and outcome were reviewed. Results: For all operations, the length of the pedicle dissection will not exceed 1 cm because of the vascular anatomy of the SGAP, which lies adjacent to the sacral region. Due to short pedicle dissection, all SGAP flap were elevated around an hour. All flaps survived except two, which had partial flap necrosis and were finally treated by contralateral V-Y advancement flaps coverage. The mean follow-up period was 14.8 months (range 3-24). No flap surgery-related mortality was found. Conclusion: Perforator-based flaps have become popular in modern reconstructive surgery because of low donor site morbidity and good preservation of muscle. Our study shows that deep pedicle dissection is unnecessary when the surgery involves an accurate indicating perforator, adequate flap size design, and correct selection of flap utilization between tunnel and rotation. The advantages of this modification include a faster operation, less bleeding, and less trauma of the pedicle, which make the SGAP flaps an alternative choice for sacral sores coverage. © 2014 JMS.
Original languageEnglish
Pages (from-to)66-71
Number of pages6
JournalJournal of Medical Sciences (Taiwan)
Volume34
Issue number2
DOIs
Publication statusPublished - 2014
Externally publishedYes

Fingerprint

Perforator Flap
General Hospitals
Arteries
Dissection
Reconstructive Surgical Procedures
Wounds and Injuries
Sacrococcygeal Region
Tissue Donors
Pilonidal Sinus
Morbidity
Unnecessary Procedures
Muscles
Pressure Ulcer
Blood Vessels
Length of Stay
Anatomy
Necrosis
Hemorrhage
Mortality

Keywords

  • Reconstruction
  • Sacral sore
  • Superior gluteal artery perforator flap
  • Acinetobacter baumannii
  • adult
  • aged
  • article
  • Candida albicans
  • clinical article
  • debridement
  • decubitus
  • donor site
  • Doppler flowmetry
  • Entamoeba coli
  • Enterococcus faecalis
  • female
  • gluteus maximus muscle
  • graft necrosis
  • human
  • immobility
  • male
  • middle aged
  • pilonidal sinus
  • Pseudomonas aeruginosa
  • sacral defect
  • sacrum
  • skin injury
  • skin transplantation
  • Staphylococcus aureus
  • superior gluteal artery perforator flap
  • very elderly
  • wound dehiscence
  • young adult

Cite this

Ten-year experience of superior gluteal artery perforator flap for reconstruction of sacral defects in tri-service general hospital. / Lin, Chin-Ta; Dai, Niann-Tzyy; Chang, Shun-Cheng; Chen, Shyi-Gen; Chen, Tim-Mo; Wang, Hsian-Jenn; Tzeng, Yuan-Sheng.

In: Journal of Medical Sciences (Taiwan), Vol. 34, No. 2, 2014, p. 66-71.

Research output: Contribution to journalArticle

Lin, Chin-Ta ; Dai, Niann-Tzyy ; Chang, Shun-Cheng ; Chen, Shyi-Gen ; Chen, Tim-Mo ; Wang, Hsian-Jenn ; Tzeng, Yuan-Sheng. / Ten-year experience of superior gluteal artery perforator flap for reconstruction of sacral defects in tri-service general hospital. In: Journal of Medical Sciences (Taiwan). 2014 ; Vol. 34, No. 2. pp. 66-71.
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abstract = "Background: Despite advances in reconstruction techniques, sacral sores continue to present a challenge to the plastic surgeon. The superior gluteal artery perforator (SGAP) flap is a reliable flap that preserves the entire contralateral side as a future donor site. On the ipsilateral side, the gluteal muscle itself is preserved and all flaps based on the inferior gluteal artery are still possible. However, the dissection of the perforator is tedious and carries a risk of compromising the perforator vessels. Patients and Methods: During the period between April 2003 and March 2013, 30 patients presented to our section with sacral wounds causing by pressure sores or infected pilonidal cysts. Of a total of 30 patients, 13 were female and 17 were male. Their ages ranged from 22 to 92 years old (mean 79.8 years old). Surgical intervention was performed electively with immediate or delayed reconstruction using a SGAP flap. The characteristics of patients' age, and sex, and cause of sacral defect, co-morbidities, wound culture, flap size, perforator number, hospital stay, and outcome were reviewed. Results: For all operations, the length of the pedicle dissection will not exceed 1 cm because of the vascular anatomy of the SGAP, which lies adjacent to the sacral region. Due to short pedicle dissection, all SGAP flap were elevated around an hour. All flaps survived except two, which had partial flap necrosis and were finally treated by contralateral V-Y advancement flaps coverage. The mean follow-up period was 14.8 months (range 3-24). No flap surgery-related mortality was found. Conclusion: Perforator-based flaps have become popular in modern reconstructive surgery because of low donor site morbidity and good preservation of muscle. Our study shows that deep pedicle dissection is unnecessary when the surgery involves an accurate indicating perforator, adequate flap size design, and correct selection of flap utilization between tunnel and rotation. The advantages of this modification include a faster operation, less bleeding, and less trauma of the pedicle, which make the SGAP flaps an alternative choice for sacral sores coverage. {\circledC} 2014 JMS.",
keywords = "Reconstruction, Sacral sore, Superior gluteal artery perforator flap, Acinetobacter baumannii, adult, aged, article, Candida albicans, clinical article, debridement, decubitus, donor site, Doppler flowmetry, Entamoeba coli, Enterococcus faecalis, female, gluteus maximus muscle, graft necrosis, human, immobility, male, middle aged, pilonidal sinus, Pseudomonas aeruginosa, sacral defect, sacrum, skin injury, skin transplantation, Staphylococcus aureus, superior gluteal artery perforator flap, very elderly, wound dehiscence, young adult",
author = "Chin-Ta Lin and Niann-Tzyy Dai and Shun-Cheng Chang and Shyi-Gen Chen and Tim-Mo Chen and Hsian-Jenn Wang and Yuan-Sheng Tzeng",
note = "Export Date: 21 March 2016 通訊地址: Tzeng, Y.-S.; Department of Surgery, Division of Plastic and Reconstructive Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; 電子郵件: aarondakimo@yahoo.com.tw 參考文獻: Minami, R.T., Mills, R., Pardoe, R., Gluteus maximus myocutaneous flaps for repair of pressure sores (1977) Plast Reconstr Surg, 60, pp. 242-249; Parry, S.W., Mathes, S.J., Bilateral gluteus maximus myocutaneous advancement flaps: Sacral coverage for ambulatory patients (1982) Ann Plast Surg, 8, pp. 443-445; Stevenson, T.R., Pollock, R.A., Rohrich, R.J., Vanderkolk, C.A., The gluteus maximus musculocutaneous island flap: Refinements in design and application (1987) Plast Reconstr Surg, 79, pp. 761-768; Koshima, I., Moriguchi, T., Soeda, S., Kawata, S., Ohta, S., Ikeda, A., The gluteal perforator-based flap for repair of sacral pressure sores (1993) Plast Reconstr Surg, 91, pp. 678-683; Verpaele, A.M., Blondeel, P.N., van Landuyt, K., Tonnard, P.L., Decordier, B., Monstrey, S.J., The superior gluteal artery perforator flap: An additional tool in the treatment of sacral pressure sores (1999) Br J Plast Surg, 52, pp. 385-391; 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) Plast Reconstr Surg, 102, pp. 765-772; Acart{\"u}rk, T.O., Parsak, C.K., Sakman, G., Demircan, O., 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) Plast Reconstr Surg, 120, pp. 1551-1556; Coşkunfirat, O.K., Ozgentaş, H.E., Gluteal perforator flaps for coverage of pressure sores at various locations (2004) Plast Reconstr Surg, 113, pp. 2012-2017; Meltem, C., Esra, C., Hasan, F., Ali, D., The gluteal perforator-based flap in repair of pressure sores (2004) Br J Plast Surg, 57, pp. 342-347; Lee, J.T., Hsiao, H.T., Tung, K.Y., Ou, S.Y., Gluteal perforator flaps for coverage of pressure sores at various locations (2006) Plast Reconstr Surg, 117, pp. 2507-2508",
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TY - JOUR

T1 - Ten-year experience of superior gluteal artery perforator flap for reconstruction of sacral defects in tri-service general hospital

AU - Lin, Chin-Ta

AU - Dai, Niann-Tzyy

AU - Chang, Shun-Cheng

AU - Chen, Shyi-Gen

AU - Chen, Tim-Mo

AU - Wang, Hsian-Jenn

AU - Tzeng, Yuan-Sheng

N1 - Export Date: 21 March 2016 通訊地址: Tzeng, Y.-S.; Department of Surgery, Division of Plastic and Reconstructive Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; 電子郵件: aarondakimo@yahoo.com.tw 參考文獻: Minami, R.T., Mills, R., Pardoe, R., Gluteus maximus myocutaneous flaps for repair of pressure sores (1977) Plast Reconstr Surg, 60, pp. 242-249; Parry, S.W., Mathes, S.J., Bilateral gluteus maximus myocutaneous advancement flaps: Sacral coverage for ambulatory patients (1982) Ann Plast Surg, 8, pp. 443-445; Stevenson, T.R., Pollock, R.A., Rohrich, R.J., Vanderkolk, C.A., The gluteus maximus musculocutaneous island flap: Refinements in design and application (1987) Plast Reconstr Surg, 79, pp. 761-768; Koshima, I., Moriguchi, T., Soeda, S., Kawata, S., Ohta, S., Ikeda, A., The gluteal perforator-based flap for repair of sacral pressure sores (1993) Plast Reconstr Surg, 91, pp. 678-683; Verpaele, A.M., Blondeel, P.N., van Landuyt, K., Tonnard, P.L., Decordier, B., Monstrey, S.J., The superior gluteal artery perforator flap: An additional tool in the treatment of sacral pressure sores (1999) Br J Plast Surg, 52, pp. 385-391; 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) Plast Reconstr Surg, 102, pp. 765-772; Acartürk, T.O., Parsak, C.K., Sakman, G., Demircan, O., 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) Plast Reconstr Surg, 120, pp. 1551-1556; Coşkunfirat, O.K., Ozgentaş, H.E., Gluteal perforator flaps for coverage of pressure sores at various locations (2004) Plast Reconstr Surg, 113, pp. 2012-2017; Meltem, C., Esra, C., Hasan, F., Ali, D., The gluteal perforator-based flap in repair of pressure sores (2004) Br J Plast Surg, 57, pp. 342-347; Lee, J.T., Hsiao, H.T., Tung, K.Y., Ou, S.Y., Gluteal perforator flaps for coverage of pressure sores at various locations (2006) Plast Reconstr Surg, 117, pp. 2507-2508

PY - 2014

Y1 - 2014

N2 - Background: Despite advances in reconstruction techniques, sacral sores continue to present a challenge to the plastic surgeon. The superior gluteal artery perforator (SGAP) flap is a reliable flap that preserves the entire contralateral side as a future donor site. On the ipsilateral side, the gluteal muscle itself is preserved and all flaps based on the inferior gluteal artery are still possible. However, the dissection of the perforator is tedious and carries a risk of compromising the perforator vessels. Patients and Methods: During the period between April 2003 and March 2013, 30 patients presented to our section with sacral wounds causing by pressure sores or infected pilonidal cysts. Of a total of 30 patients, 13 were female and 17 were male. Their ages ranged from 22 to 92 years old (mean 79.8 years old). Surgical intervention was performed electively with immediate or delayed reconstruction using a SGAP flap. The characteristics of patients' age, and sex, and cause of sacral defect, co-morbidities, wound culture, flap size, perforator number, hospital stay, and outcome were reviewed. Results: For all operations, the length of the pedicle dissection will not exceed 1 cm because of the vascular anatomy of the SGAP, which lies adjacent to the sacral region. Due to short pedicle dissection, all SGAP flap were elevated around an hour. All flaps survived except two, which had partial flap necrosis and were finally treated by contralateral V-Y advancement flaps coverage. The mean follow-up period was 14.8 months (range 3-24). No flap surgery-related mortality was found. Conclusion: Perforator-based flaps have become popular in modern reconstructive surgery because of low donor site morbidity and good preservation of muscle. Our study shows that deep pedicle dissection is unnecessary when the surgery involves an accurate indicating perforator, adequate flap size design, and correct selection of flap utilization between tunnel and rotation. The advantages of this modification include a faster operation, less bleeding, and less trauma of the pedicle, which make the SGAP flaps an alternative choice for sacral sores coverage. © 2014 JMS.

AB - Background: Despite advances in reconstruction techniques, sacral sores continue to present a challenge to the plastic surgeon. The superior gluteal artery perforator (SGAP) flap is a reliable flap that preserves the entire contralateral side as a future donor site. On the ipsilateral side, the gluteal muscle itself is preserved and all flaps based on the inferior gluteal artery are still possible. However, the dissection of the perforator is tedious and carries a risk of compromising the perforator vessels. Patients and Methods: During the period between April 2003 and March 2013, 30 patients presented to our section with sacral wounds causing by pressure sores or infected pilonidal cysts. Of a total of 30 patients, 13 were female and 17 were male. Their ages ranged from 22 to 92 years old (mean 79.8 years old). Surgical intervention was performed electively with immediate or delayed reconstruction using a SGAP flap. The characteristics of patients' age, and sex, and cause of sacral defect, co-morbidities, wound culture, flap size, perforator number, hospital stay, and outcome were reviewed. Results: For all operations, the length of the pedicle dissection will not exceed 1 cm because of the vascular anatomy of the SGAP, which lies adjacent to the sacral region. Due to short pedicle dissection, all SGAP flap were elevated around an hour. All flaps survived except two, which had partial flap necrosis and were finally treated by contralateral V-Y advancement flaps coverage. The mean follow-up period was 14.8 months (range 3-24). No flap surgery-related mortality was found. Conclusion: Perforator-based flaps have become popular in modern reconstructive surgery because of low donor site morbidity and good preservation of muscle. Our study shows that deep pedicle dissection is unnecessary when the surgery involves an accurate indicating perforator, adequate flap size design, and correct selection of flap utilization between tunnel and rotation. The advantages of this modification include a faster operation, less bleeding, and less trauma of the pedicle, which make the SGAP flaps an alternative choice for sacral sores coverage. © 2014 JMS.

KW - Reconstruction

KW - Sacral sore

KW - Superior gluteal artery perforator flap

KW - Acinetobacter baumannii

KW - adult

KW - aged

KW - article

KW - Candida albicans

KW - clinical article

KW - debridement

KW - decubitus

KW - donor site

KW - Doppler flowmetry

KW - Entamoeba coli

KW - Enterococcus faecalis

KW - female

KW - gluteus maximus muscle

KW - graft necrosis

KW - human

KW - immobility

KW - male

KW - middle aged

KW - pilonidal sinus

KW - Pseudomonas aeruginosa

KW - sacral defect

KW - sacrum

KW - skin injury

KW - skin transplantation

KW - Staphylococcus aureus

KW - superior gluteal artery perforator flap

KW - very elderly

KW - wound dehiscence

KW - young adult

U2 - 10.4103/1011-4564.131895

DO - 10.4103/1011-4564.131895

M3 - Article

VL - 34

SP - 66

EP - 71

JO - Journal of Medical Sciences

JF - Journal of Medical Sciences

SN - 1011-4564

IS - 2

ER -