Feasibility of a Deepithelialized Superior Gluteal Artery Perforator Propeller Flap for Various Lumbosacral Defects

Abstract

Skin and soft tissue defects in the lumbosacral area are commonly encountered in the field of reconstructive surgery, and it is well documented that the superior gluteal artery perforator (SGAP) flap provides excellent coverage of these defects. In this article, we describe our experience using a modified version of the SGAP propeller flap, in which the distal redundant portion of an elevated SGAP flap is deepithelialized, thereby maximizing the effect of the soft tissue augmentation. Thirteen patients with lumbosacral soft tissue defects treated between May 2010 and June 2012 were included in this study. The wound causes were pressure ulcer (n = 9), pseudomeningocele (n = 2), and hardware exposure (n = 2). In all patients, an elevated SGAP flap was rotated 180 degrees over the defect area and the extra distal portion of the flap was deepithelialized and used as a soft tissue filler or tamponade. During the follow-up period (mean, 26 months), 12 of 13 flaps survived completely. One flap was totally necrosed due to progressive venous congestion and was reconstructed with local advancement flaps. No further complications were noted. Because of the redundancy and pliability of the tissue in the gluteal area, a flap relatively wider or longer than the defect can be elevated safely. Hence, the redundant tissue volume can be tucked inside to facilitate soft tissue augmentation of the area. We propose that the deepithelialized version of the SGAP propeller flap is an effective option for the reconstruction of various lumbosacral soft tissue defects because it offers thick and healthy soft tissue from a distant site to the defect areas.

Free-style Deepithelialized Propeller Flaps: An Ideal Local Flap to Obliterate Wounds with Dead Space

“…1,2,8,13,14,18 The gluteal muscle flap is useful to cover lower posterior trunk defects, and in larger defects, multiple muscle flaps may be used together to achieve satisfactory coverage but may result in significantly increased donor side morbidity. 1,2,5,10,13,14 Thus, to overcome these limits, we searched for a flap that provides larger bulk, better reach, and reliable vascular supply.…”

“…Deepithelializing part of the flap to obliterate dead space is not new. Using a random pedicled flap, Hill and Riaz 6 first described the deepithelialized gluteus maximus island flap to obliterate a cerebrospinal fluid (CSF) leak and Moon et al 5 published a series of 13 cases of partially deepithelialized superior gluteal artery perforator flaps for small lumbosacral defects. We also use similar approaches when the defect is small and close to the recipient pedicle allowing the arc of rotation and advancement to reach the defect.…”

“…Previously, a partially deepithelialized superior gluteal artery perforator propeller flap was used to cover lower midline defects of the back. 5,6 But with the increased knowledge on perforasomes and free-style approach, custom-designed propeller flaps can be based on any perforator and any part of the body with an acceptable scar in the donor site while maintaining the muscle function beneath the skin. 7–12 In this article, we report our experience with totally deepithelialized propeller flap buried to obliterate various posterior trunk defects with dead space.…”

Colgajo de perforantes de la arteria glútea superior para reconstrucción de defecto en región lumbosacra: reporte de un caso

“…De tal manera que el desbridamiento quirúrgico y la subsecuente reconstrucción son el tratamiento indicado 5,6,7 . El colgajo músculo cutáneo de glúteo mayor es útil en el cubrimiento de estos defectos.…”

Trilobed pedicled superior gluteal artery perforator flap for lumbosacral defect coverage

“…It is important not only to cover the external defect, but also to fill the dead space with adequate soft tissue. Surgeons can choose between the musculocutaneous flap, fasciocutaneous flap, pedicled superior gluteal artery perforator (SGAP) flap, pedicled inferior gluteal artery perforator flap, or free flaps (Moon et al, ).…”