Sensory Innervated Superior Gluteal Artery Perforator Flap for Reconstruction of Sacral Wound Defect

Cheong, Ee Cherk; Wong, Marcus; Ong, Wei Chen; Lim, Jane; Lim, Thiam Chye

doi:10.1097/01.prs.0000153806.25815.d8

Cited by 11 publications

(10 citation statements)

References 15 publications

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“…For this reason some authors have advocated using partial muscle mass. Verpaele et al 18 expressed that only a little amount of bleeding or blood loss is encountered in this flap as the dissection does not cut muscle but splits them along their fibers. This is also important in nonparaplegic patients as it reduces postoperative pain and mobilization can be started early.…”

Section: Discussionmentioning

confidence: 98%

“…This is also important in nonparaplegic patients as it reduces postoperative pain and mobilization can be started early. 18 Recently many authors have used the gluteal perforator flaps successfully for the coverage of the defects of sacral decubitus sores. 3,6,14 -18 These flaps have many advantages over traditional musculocutaneous flaps.…”

Section: Discussionmentioning

confidence: 99%

“…10 -13 Although many authors emphasized advantages of the perforator flaps for closure of the sacral pressure sores, 3,6,14 -17 assessment of precise location of the perforators' vessels in the gluteal perforator flaps is usually difficult. 3,6,7,17,18 Also dissection of the perforator vessels is the most time consuming and difficult part of the operation. Color Doppler ultrasonography has been improved dramatically and can now enable recognition of very small vessels.…”

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confidence: 99%

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Preoperative Color Doppler Assessment in Planning of Gluteal Perforator Flaps

İşken

Alagöz²,

Onyedi³

et al. 2009

Annals of Plastic Surgery

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Gluteal artery perforator flaps have gained popularity due to reliability, preservation of the muscle, versatility in flap design without restricting other flap options, and low donor-site morbidity in ambulatory patients and possibility of enabling future reconstruction in paraplegic patients. But the inconstant anatomy of the vascular plexus around the gluteal muscle makes it hard to predict how many perforators are present, what their volume of blood flow and size are, where they exit the overlying fascia, and what their course through the muscle will be. Without any prior investigations, the reconstructive surgeon could be surprised intraoperatively by previous surgical damage, scar formation, or anatomic variants.For these reasons, to confirm the presence and the location of gluteal perforators preoperatively we have used color Doppler ultrasonography. With the help of the color Doppler ultrasonography 26 patients, 21 men and 5 women, were operated between the years 2002 and 2007. The mean age of patients was 47.7 (age range: 7-77 years). All perforator vessels were marked preoperatively around the defect locations. The perforator based flap that will allow primary closure of the donor site and the defect without tension was planned choosing the perforator that showed the largest flow in color Doppler ultrasonography proximally. Perforators were found in the sites identified with color Doppler ultrasonography in all other flaps. In our study, 94.4% flap viability was ensured in 36 perforator-based gluteal area flaps. Mean flap elevation time was 31.9 minutes. We found that locating the perforators preoperatively helps to shorten the operation time without compromising a reliable viability of the perforator flaps, thus enabling the surgeon easier treatment of pressure sores.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Preoperative Color Doppler Assessment in Planning of Gluteal Perforator Flaps

İşken

Alagöz²,

Onyedi³

et al. 2009

Annals of Plastic Surgery

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“…Cheong et al have previously reported a sensate SGAP flap based on the sacral nerves, which emerge 2–3 cm from the lateral border of the sacrum and travel laterally (Cheong et al, 2005). However, this region is often damaged by pressure ulcers.…”

Section: Discussionmentioning

confidence: 99%

Sacral defect reconstruction using a sensate superior gluteal artery perforator flap based on the superior cluneal nerves: A report of two cases

et al. 2021

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The superior gluteal artery perforator (SGAP) flap is a widely used flap for sacral reconstruction. However, it is non‐sensate flap and sensory loss is one of the most important risk factors for pressure ulcer development and recurrence; therefore, a sensate SGAP flap would be ideal for the reconstruction. Because the upper buttock is innervated by the superior cluneal nerves (SCNs) which originate from Th11 to L4, a sensate SGAP flap based on SCNs is anatomically possible. Herein, we present a novel sensate SGAP flap based on SCNs for reconstruction of sacral defects. Two patients with a sacral defect underwent reconstruction using a sensate SGAP flap (53 and 56 years old, both men). Diagnoses were sacral spindle cell sarcoma and sacral pressure ulcer. The defect sizes were 16 × 13 and 12 × 11 cm. The flap was designed based on the locations of SCNs which are commonly located at 6–8 cm lateral from the midline at the iliac crest. Flap sizes were 16 × 9 and 15 × 13 cm, respectively. The flaps survived completely in both cases. Flap sensation was observed immediately after surgery except in flap margins. However, sensory recovery occurred in these areas as well several months postoperatively. None of the patients developed postoperative pressure ulcers during the follow‐up period of 37 and 13 months. This method may preserve flap sensation and therefore can contribute to reducing the risk of postoperative pressure ulcers and could be a useful option for sacral reconstruction.

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“…The posterior divisions of the lateral cutaneous branches of the intercostal nerves can be included in thoracodorsal artery perforator flaps and used for neural coaptations (Lin et al, 2009). Harvested nerves can have coaptation with the superior cluneal (Iida et al, 2021) or sacral nerves (Cheong et al, 2005), also known as sensory nerves that innervate the buttock area. However, considering that most of the recalcitrant sore patients are paraplegia due to cord injury, sensory innervation should be restored through microsurgical coaptation between a flap and a sensory nerve located cranial to the level of injury (Zwanenburg et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of recalcitrant pressure ulcers with latissimus dorsi muscle‐splitting free flaps

et al. 2021

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Background: Reconstruction of recalcitrant pressure ulcers is very challenging because all available local tissues have been exhausted. Although occasionally suggested as reconstructive options in some reports, free flaps are still not favored for pressure ulcers because of the less available recipient vessels in buttock area and the need for position change. Here, we describe our experience with latissimus dorsi muscle-splitting free flaps harvested in prone position for recalcitrant pressure ulcers.Methods: Between January 2012 and January 2020, 10 patients of recalcitrant pressure ulcers underwent reconstruction using latissimus dorsi muscle-splitting free flaps. To harvest flaps in the prone position, the curvilinear incision was made along the line connecting the lateral border of the scapula and the midaxillary line of the armpit and the latissimus dorsi muscle was split just below the skin incision. Only the required amount of muscle was harvested including the 5 Â 3 cm sized muscle cuff around bifurcation points of the transverse and descending branches.Results: Flap size ranged from 16 Â 9 to 24 Â 14 cm and the gluteal vessels were mainly used as recipients. The mean operation time was 170 mins. All the flaps survived but two patients suffered wound disruption and partial flap loss, respectively.During the mean follow-up periods of 2.45 years, there were no recurrences at the reconstruction site, and no patient complained of donor site morbidity.Conclusions: Based on the results obtained from this consecutive series of patients, latissimus dorsi muscle-splitting free flaps are valuable option for recalcitrant pressure ulcer reconstruction.

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Sensory Innervated Superior Gluteal Artery Perforator Flap for Reconstruction of Sacral Wound Defect

Cited by 11 publications

References 15 publications

Preoperative Color Doppler Assessment in Planning of Gluteal Perforator Flaps

Preoperative Color Doppler Assessment in Planning of Gluteal Perforator Flaps

Sacral defect reconstruction using a sensate superior gluteal artery perforator flap based on the superior cluneal nerves: A report of two cases

Reconstruction of recalcitrant pressure ulcers with latissimus dorsi muscle‐splitting free flaps

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