A Single Superior Gluteal Artery Perforator Flap in Reconstruction of Large Midline Sacral Defects
| Autor: | Tamer Seyhan, Vasil Ercüment Erbaş, Fuat Baris Bengur, Tahsin Oğuz Acartürk |
|---|---|
| Přispěvatelé: | Tıp Fakültesi |
| Rok vydání: | 2022 |
| Předmět: |
Adult
Male medicine.medical_specialty Midline Defects Dissection (medical) Dehiscence Complete flap loss Perforator Flaps Superior gluteal artery medicine.artery medicine Humans Recipient site Aged Sacral Defects business.industry Soft tissue Arteries Middle Aged Plastic Surgery Procedures medicine.disease Superior Gluteal Artery Perforator Surgery Buttocks Female Sacral defects business Gluteal area Perforator Flap |
| Zdroj: | Annals of Plastic Surgery. 88:313-318 |
| ISSN: | 1536-3708 0148-7043 |
| DOI: | 10.1097/sap.0000000000002935 |
| Popis: | Background Large midline sacral defects are reconstructive challenges. Superior gluteal artery perforator (SGAP) flap provides enough tissue and versatility to cover large defects; however, a single flap may be insufficient. We present a technique to cover large defects using single SGAP flaps. Methods Large sacral defects (>100 cm2) reconstructed with single SGAP flaps were included. Angle of transposition (45°-60°) was determined based on the tissue laxity and mobility of gluteal area. Perforator identification, intramuscular dissection, or skeletonization was not performed. Outcomes were measured as achieving durable reconstruction, flap viability, and complications. Results There were 17 patients (12 male, 5 females; aged 25-72 years) with different etiologies. The mean flap surface area (136.1 ± 45.6 cm2, between 9 × 8 and 26 × 10 cm) was smaller than the mean defect surface area (211.1 ± 87.2 cm2, between 10 × 10 and 28 × 14 cm) (P < 0.001). All flaps survived with no partial or complete flap loss. Minor dehiscence in 4 patients (2 at donor site and 2 at recipient site) healed with dressing changes or using negative-pressure vacuum therapy. All patients had durable outcomes without any recurrence. Conclusion Single unilateral SGAP flaps can be used to completely cover midline large sacral defects. It is important to design the flaps to have a joint side with the defect in the proximal part and use the intrinsic mobility of gluteal soft tissues for the closure. Flaps can be (1) planned to be smaller than the defects, (2) harvested with no intramuscular perforator dissection or pedicle skeletonization, and (3) transposed with an angle less than 60°. |
| Databáze: | OpenAIRE |
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