Septocutaneous gluteal artery perforator flap in breast reconstruction: An insight into the related anatomy and preoperative imaging

• Published in: Journal of plastic, reconstructive & aesthetic surgery Vol. 74; no. 10; pp. 2580 - 2587
• Main Authors: Rodriguez-Vegas, M., De Juan Huelves, A., Benito Duque, P.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-10-2021
• Subjects: Autologous breast reconstruction; Computed tomography angiography; Free tissue flap; Septocutaneous gluteal artery perforator flap; Computed tomography angiography; Free tissue flap; Septocutaneous gluteal artery perforator flap; Autologous breast reconstruction
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2021.03.057

Although without a widespread popularity, the septocutaneous gluteal artery perforator flap (sc-GAP) can be an excellent choice in breast reconstruction. The purpose of the article is to further study the preoperative imaging anatomy and surgical technique for a safe operation.
A clinical experience in four unilateral breast reconstructions is reported, and an analysis is made of the computed tomography angiography (CTA) variables (36 studies/72 sides) that might define the microsurgical consistency and reliability of the technique.
After a careful preoperative imaging evaluation, the surgical operation confirmed a predictable, although not straightforward, anatomy. All the flaps were raised in the supine position. With a remarkably quick postoperative recovery, the resulting scar was well hidden and did not significantly distort the gluteal aesthetics although contralateral contouring liposuction might be desirable in unilateral cases. Good aesthetic results were obtained in all the patients. In the evaluation of the CTA studies, a right/left septocutaneous perforator arising from the superficial branch of the superior gluteal artery could be found in 80.6% of the patients, with a few patients having 2-3 perforators on one side. Although with an overall suitable pedicle length (mean 7.4 cm), the arterial diameter at the suture site was found to be small (mean 1.6 mm).
Given the adequate body habitus and reconstructive requirements, the sc-GAP can be a good choice even in large breasts. However, the technique requires the appropriate surgical expertise and mandates a thorough preoperative imaging evaluation that defines whether the technique should be done in a particular patient.