The identification of the number, location, size and pathways of gluteal perforators by computed tomographic angiography cta technology has revolutionised the way surgeons approach the sgap and igap flaps. Koshima et al initially described a pedicled gluteal perforator flap in 1993 but it was based on short parasacral perforating vessels. Skin and fat from near the armpit area and side of the back are transferred to reconstruct defects of the. Our center pioneered bilateral superior gluteal artery perforator sgap breast reconstruction in 2005. Does a flap reconstruction, such as tug or sgap, go under the. Pedicled perforator flaps are also called local perforator flaps, or island perforator flaps. Superior and inferior gluteal artery perforator flaps sgap.
Body lift perforator flap reconstruction uses a flap of tissue from both sides of the lower abdomen diep and the upper buttocks sgap, or hip flap to reconstruct the breasts two flaps per breast, or four flaps in all. A a lumbar artery perforator flap lap flap uses the soft tissue of the waistline at the lower back and the flank the lovehandle area to reconstruct a breast. Mar 07, 2019 an sgap flap superior gluteal artery perforator, or gluteal perforator hip flap, uses this blood vessel, as well as a section of skin and fat from your upper buttockship the socalled love handles to reconstruct the breast. Sgap flap breast reconstruction by top rated surgeons in. Gap flap breast reconstruction prma plastic surgery. The sgap flap, or superior gluteal artery perforator flap, was developed by dr.
Women who do not have an adequate amount of abdominal tissue for a diep flap or siea flap reconstruction may be candidates for gap gluteal artery perforator flap breast reconstruction. This new edition has been updated to include ten new chapters and extensive updates on all existing chapters. Is an sgap flap complicated for surgeons to do and for patients to recover. Much of the breast reconstruction using your bodys own tissue can be accomplished at the time of your mastectomy immediate reconstruction, though sometimes it can be done as a separate procedure later delayed reconstruction. Gluteal vy advancement perforator flap lambeau perforant gluteal. The gap gluteal artery perforator uses skin and fat from your tushy buttocks and depending on whether your surgeon uses the upper portion sgap superior gluteal artery perforator or the lower portion igap, inferior gluteal artery perforator will be a decision that you either make together, or solely by your surgeon in the operating room. Youll be moved to the recovery room after surgery, where hospital staff members will monitor your heart rate, body temperature, and blood pressure. The first patient was a 52yearold woman who had undergone previous attempts at breast reconstruction with a failed transverse rectus abdominis muscle tram flap and a failed implant. Perforator flaps are described according to the main artery of origin e. Living fat is transplanted to the chest from unwanted excess from the upper hip region to give back.
In contrast to the other wellknown diep deep inferior epigastric perforator and sgap superior gluteal artery perforator flaps that provide bulk, the tap flap provides a relatively thin and pliable skin paddle. In this lower position, the feeding vasculature emanates from the inferior gluteal artery, which passes below the piriformis muscle in. What are the advantages and disadvantages of perforator. The abdomen is the most common donor site, since excess fat and skin are usually found in this area. Types of reconstruction surgery the gap flap incl igap.
Not a whole lot of tissue comes along with a tug or an sgap flap which may be fine you may have been and want to still be smaller breasted of course i. Breast reconstruction sgap superior gluteal artery perforator flap the gluteal region also serves as an additional alternative to abdominalbased reconstruction. The pap flap for breast reconstruction was originated in 2010 by dr. For patients who do not have enough abdominal tissue for an effective diep flap, a technique called a superior gluteal artery perforator sgap flap is often used instead. The superior gluteal artery perforator flap for reconstruction of sacral. Does a flap reconstruction, such as tug or sgap, go under.
The sgap flap reconstruction, or the superior gluteal artery perforator flap buttock flap, is ideal for those who do not have an adequate amount of excess tummy tissue. The superior gluteal artery perforator sgap flap allows for harvest of the upper glutealhip fat pad. The sgap flap has been primarily used as an alternate for breast reconstruction, and requires significant microsurgical experience to harvest. Preoperative doppler study mapping of the perforators may be helpful in flap design and dissection. Sgap flap procedure center breast reconstruction paterson. Description, classification, and nomenclature of perforator flaps.
For women who are thin, cannot, or do not wish, to use their abdomen or thigh as the source tissue donor site for breast reconstruction the igap or sgap flap may be an excellent choice. However, the anatomic variations decreased its popularity. The vessels that supply blood to the flap are isolated perforators derived from a deep vascular system through the underlying muscle or intermuscular septa. Perforator flap surgery was described as extravagant and exceptional in those days but it has now become the mainstream reconstructive technique for restoring defects throughout the body. For more information about breast reconstruction with the diep or sgap flap, please contact dr. This location represents a juncture point between aesthetic units and results in a very acceptable donor site contour. Breast reconstruction with flap surgery mayo clinic. Most importantly, the donorsite morbidity is minimal.
They tried to classify perforators according to perforators. Breast reconstruction perforator flap microsurgery gap sgap igap. Superior and inferior gluteal artery perforator flaps. The sgap flap, which has reliable blood supply, preserves the gluteus maximus muscle and could be transferred simply and safely, is an ideal and reusable. The sgap flap is taken from the buttock and is based on the superior gluteal artery, which arises from the. Igap flap surgery is less commonly done than the other type of gap flap, the sgap superior gluteal artery perforator flap or hip flap, which uses tissue from top section of the buttocks, high up on the hip.
Many new developments have taken place in the field, including the use of local perforator flaps, including freestyle propeller flaps as well as. The breast may be reconstructed with the skin, fat, and the tiny blood vessels taken from the buttock area to achieve a b or c cup breast size. The underlying gluteus maximus buttock muscle is entirely preserved with this operation. For women who are thin, cannot, or do not wish, to use their abdomen or thigh as the source tissue donor site for breast reconstruction, the superior gluteal artery perforator, or sgap, flap may be an excellent choice. Unlike conventional tram flap reconstructions, use of our refined perforator flap techniques allow for collection of this tissue without sacrifice of underlying abdominal muscles. This perforator flap allows for the transfer of the patients own skin and. Diep, sgap, pap, siea, and icap flap are natural breast reconstructive surgeries using tissue lifted from a donor site and moved to a recipient site with an intact blood supply. Types of reconstruction surgery the gap flap incl igap, sgap.
Superior gluteal artery perforator flap request pdf. Before and after superior gluteal artery perforator sgap flap donor site same patient as in previous image. Sgap breast reconstruction what is sgap breast reconstruction. Perforator flap surgery is a technique used in reconstructive surgery where skin andor subcutaneous fat are removed from a distant or adjacent part of the body to reconstruct the excised part. Because no muscle is used, an sgap flap is considered a musclesparing type of flap. This tissue is then surgically transformed into a new breast mound. How is a superior gluteal artery perforator sgap flap. The patient is preoperatively marked for the flap chosen. The most frequently used perforator flaps nowadays are the deep inferior epigastric perforator flap diep flap, and both the superior and inferior gluteal sgap igap flap, all three mainly used for breast reconstruction. The sgap flap is a safe and reliable perforator flap providing a good breast projection, cosmetically pleasing outcome on the breast, and an acceptable outcome on the buttock with the disadvantage.
This book is an essential authoritative guide for plastic surgeons interested in making perforator flap reconstruction part of their practice. Skin and fat from the mid and upper buttock over the gluteus maximus muscle. Superior gluteal artery perforator sgap flap microsurgeon. The book outlines techniques for flap harvest, from the most basic to the highly advanced. The s gap flap is taken from the buttock and is based on the superior gluteal artery, which arises from the internal iliac artery and exits the pelvis superior to the piriformis muscle figs.
Breast reconstruction with gluteal artery perforator flaps diep flap. Perforator flap options for breast reconstruction include. The superior gluteal artery perforator sgap flap uses tissue from the top of the buttocks to create breast tissue. For patients without adequate excess abdominal or tummy tissue, surgeons utilize the sgap flap, or the superior gluteal artery perforator flap buttocks, to reconstruct the breast. Perforator flaps for breast reconstruction ebook www. Looking for online definition of sgap or what sgap stands for. With this new advent of perforator flap techniques, it is the most innovative and stateoftheart technique used today in breast reconstruction, let alone plastic surgery as a whole. Part 1 outlines the fundamental concepts in perforator flap surgery. A direct defatting of the sgap flap can be safely done away from the surrounding area where the perforator enters the flap. Breast reconstruction with flap surgery is a complex procedure performed by a plastic surgeon.
The editors, leading reconstructive surgeons and pioneers in the field of perforator flap surgery, have assembled a group of worldrenowned experts who discuss perforator anatomy and clinical indications for the use of these flaps. Mar 07, 2019 because no muscle is used, an igap flap is considered a musclesparing type of flap. The igap flap holds several advantages over the sgap flap. Tissue can be harvested from each buttock for symmetrical results.
Indications for use are multiple, spanning locoregional use as a pedicled flap to freetissue transfer in breast. A novel technique for augmenting venous outflow in the superior. This is usually done if patients do not have adequate skin and tissue in their abdomens, or have had previous abdominal surgeries that may have interfered with blood vessels that the diep flap requires. Plastic surgery perforator flaps for breast reconstruction. The superior gluteal artery and venae via perforators through the gluteus maximus muscle. A slight buttock lift results in the donor area with a fine line incision easily hidden within the panty line. Superior gluteal artery perforator flap an overview sciencedirect. The perforator dissection proceeds through adductor magnus up until its origin at the profunda vessels. Inferior gluteal artery perforator flap an overview sciencedirect. The superior gluteal artery perforator sgap flap, in particular, has. Gluteal turnover flap for perineal reconstruction after abdominoperineal resection. The tdap, or thoracodorsal artery perforator flap, is a newer method of reconstructing the breast using your own tissues after a lumpectomy. Oct 27, 2012 the gap gluteal artery perforator uses skin and fat from your tushy buttocks and depending on whether your surgeon uses the upper portion sgap superior gluteal artery perforator or the lower portion igap, inferior gluteal artery perforator will be a decision that you either make together, or solely by your surgeon in the operating room. Advantages of the sgap flap are a longer vascular pedicle and less donorsite pain and morbidity.
The sgap flap is a safe and reliable perforator flap providing a good breast projection, cosmetically pleasing outcome on the breast, and an acceptable outcome on. The thickness of fat available provides volume for unilateral reconstruction, but positioning and the donor scar deformity have made this a less popular choice even among very experienced microsurgeons. Breast reconstruction free flaps statpearls ncbi bookshelf. Suffix s is added if the flap is harvested based on direct septal or fasciocutaneous vessels. The inferior gluteal artery perforator igap flap is essentially the same operation as the superior gluteal artery perforator sgap flap, but with lower positioning of the flap on the buttock. This flap procedure is unlike a graft, which does not have an intact blood supply and therefore relies on growth of new blood vessels. Dec 23, 2015 the superior gluteal artery perforator sgap flap uses tissue from the top of the buttocks to create breast tissue. A superior gluteal artery perforator sgap flap, which is comprised of skin, tissue and blood vessels from the top of the buttocks, is a flap used to recreate the breast. It enters the gluteus maximus muscle approximately one third of the distance along the line between the posterior superior iliac spine and the greater trochanter. In a reasonably thin person, the flap ranges from 1 2 cm in thickness. The superior gluteal artery perforator sgap flap, in particular, has become a common choice when diep flaps are not an option. Patient position is either in the prone or lateral decubitus position for flap harvest.
The most frequently used perforator flaps nowadays are the deep inferior epigastric perforator flap, and both the superior and inferior gluteal sgap igap flap, all three mainly used for breast reconstruction. After a brief introduction of the concept and surgical rationale of perforator flaps, the book presents 24 different flaps from donor sites including upper limb, lower limb and the trunk. This is usually done in selected cases, and is typically used for augmenting the volume or perfecting the contour of alreadyreconstructed breasts. Depending on the shape of your body and your personal preference, several areas of the body can act as donor sites for the tissue needed to restore the shape and form of the breast. There is less donor site morbidity from the abdomen, since the muscle is left intact.
Superior gluteal artery perforator flap an overview. During the sgap flap procedure, surgeons harvest tissue and blood vessels from the top part of the buttock without injury to the underlying gluteal muscles. Feb 28, 2019 the superior gluteal artery perforator sgap flap allows for harvest of the upper glutealhip fat pad. Perforator flaps for breast reconstruction gives plastic surgeons the detailed instructions they need to perform these sophisticated breast. The first ever international course on perforator flaps icpf was organized in gent, belgium, 20 years ago in 1997, when perforator flap surgery was still in its pioneering phase. Is an sgap flap complicated for surgeons to do and for. The superior gluteal artery perforator sgap flap constitutes the descendant of the gluteus maximus myocutaneous flap.
Nonmuscle perforator flaps, in particular neurocutaneous perforator flaps, are also discussed in this section. Sep 24, 2018 is an sgap flap complicated for surgeons to do and for. The clinical application of anterolateral thigh flap. It yields a relatively long, thin and pliable skin flap and a good aesthetic result. The sgap procedure is an advanced microsurgical technique that is used to rebuild the breast lost to mastectomy. However, this may be necessary if a radical debridement of the bed sore cannot be achieved or if a cavity needs to be filled. This procedure uses excess skin and fat from the gluteal buttock region and leaves all the gluteal muscle behind. In patients with inadequate abdominal tissue or in whom an abdominal flap had been used before, gluteal flaps present an alternative for autologous breast reconstruction. Composite superior gluteal artery perforator flaps for unilateral breast reconstruction. Thoracodorsal artery perforator tdap flap harvests upper back skin and fat to create the breasts. Harvest of the sgap flap places the donor site high on the buttock at the juncture of the buttock and hip region. The largest soleus perforator flap was 15 x 9 cm, and the largest peroneal perforator flap was 9 x 4 cm. The superior and inferior gluteal artery perforators are abundant in the gluteal region.
Suffix ap artery perforator signifies a true musculocutaneous perforator flap. B a lap flap is shown here being surgically elevated. Breast sgap flap reconstruction brigham and womens hospital. We were also the first to perform the bilateral simultaneous sgap in 1994, and our experience has subsequently been published. Living fat is transplanted to the chest from unwanted excess from the upper hip region to give back volume and shape in the newly. This flap procedure is fairly rare and is for patients who dont have other options.
The anterolateral thigh flap can provide a large skin paddle nourished by a long and largecaliber pedicle and can be harvested by twoteam work. We recorded the number and location of perforators, the characteristics of the main perforator. You wont need to have any gluteal muscle cut or moved for a sgap reconstruction. Allen at the th international course on perforator flaps in mexico city. Sgap is listed in the worlds largest and most authoritative dictionary database of abbreviations and acronyms the free dictionary.
This is usually done if patients do not have adequate skin and tissue in their abdomens, or have had previous abdominal surgeries that may have interfered with blood vessels that the diep flap requires breast plastic and reconstructive surgeons at johns hopkins. This is usually done if patients do not have adequate skin and tissue in their. Program thursday, august 24, 2017 cadaver labs cadaver lab dissection the ohio state university hamilton hall room 256258 columbus, oh 43210 shuttle service provided from grand event center to ha. Skin and fat from near the armpit area and side of the back are transferred to reconstruct defects of the outer breast, usually without sacrificing muscle tissue. Based on the perforators of the superior gluteal artery, the superior gluteal artery perforator sgap flap includes tissue from the upper buttock region, leaving an inconspicuous scar at the junction of aesthetic units. The gluteal muscles are not removed or altered during sgap flap surgery.
Composite superior gluteal artery perforator flaps for unilateral. The superior gluteal artery perforator sgap flap is a useful technique for breast reconstruction. If youre in pain or feel nauseated from the anesthesia, tell someone so. The ultimate technical challenge is presented with chapters on ultrathin perforator flaps and microvascular augmented superthin flaps. The aims of this atlas are to introduce the clinical applications of perforator flaps in plastic surgery and skin replacement. Thirty gluteal flaps 15 sgap and 15 igap were studied on 22 adult fresh cadavers.
Perforator flaps were first introduced in 1992 and were developed out of a desire to further mimimize donor site morbidity and possibly recovery time without compromising safety or aesthetic outcomes. Sgap superior gluteal artery perforator flap procedure uses fat and skin from your upper buttock to create a new breast mound after a mastectomy. Several alternatives exist for breast cancer reconstruction with. Sgap flaps have particular nuances but they are no less complicated then the. What started as a small meeting among friends, has grown into a major international forum where colleagues share their new ideas in the field of perforator. Although possessing all of its predecessors advantages, the sgap flap generates much less donorsite morbidity. Simultaneous bilateral breast reconstruction with superior gluteal artery perforator sgap flaps.
By adapting freestyle flap concepts, such as preoperative mapping of the perforators and being familiar with retrograde perforator. The sgap superior gluteal artery perforator flap procedure uses tissue from the top part of the buttock without injury or sacrifice of the underlying gluteal muscles. The evolution from the sgap superior gluteal artery perforator flap to the scgap. The site of that donor tissue depends on the end result desired by the patient and the unique anatomy of that patient. The evolution from the sgap superior gluteal artery perforator flap to the sc gap. Many of the contributors to perforator flaps for breast reconstruction have pioneered the procedures presented in their respective chapters. View media gallery before and after delayed bilateral reconstruction with superior.
It provides a flap with good projection that is very suitable for breast reconstruction, especially in young patients with a projecting contralateral breast. Flap surgery diep, pap, siea, sgap, and icap flaps. The gm muscle fascia is included only in the region around the perforator. Each book has a full description and a direct link to amazon for the download. The donor site can be closed primarily if the width is less than 68 cm and can be hidden in the gluteal crease with the igap flap and under clothes with the sgap flap. Septocutaneous gluteal artery perforator scgap flap for breast.