Thirty gluteal flaps 15 sgap and 15 igap were studied on 22 adult fresh cadavers. Our center pioneered bilateral superior gluteal artery perforator sgap breast reconstruction in 2005. Gap flap breast reconstruction prma plastic surgery. 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. 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 new edition has been updated to include ten new chapters and extensive updates on all existing chapters. 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. For more information about breast reconstruction with the diep or sgap flap, please contact dr. 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. The evolution from the sgap superior gluteal artery perforator flap to the sc gap. The superior gluteal artery perforator sgap flap constitutes the descendant of the gluteus maximus myocutaneous flap. 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 aims of this atlas are to introduce the clinical applications of perforator flaps in plastic surgery and skin replacement. 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. The sgap flap, or superior gluteal artery perforator flap, was developed by dr. They tried to classify perforators according to perforators. Skin and fat from near the armpit area and side of the back are transferred to reconstruct defects of the. Breast reconstruction sgap superior gluteal artery perforator flap the gluteal region also serves as an additional alternative to abdominalbased reconstruction. Sgap flap breast reconstruction by top rated surgeons in. This location represents a juncture point between aesthetic units and results in a very acceptable donor site contour. The pap flap for breast reconstruction was originated in 2010 by dr. Harvest of the sgap flap places the donor site high on the buttock at the juncture of the buttock and hip region. Nonmuscle perforator flaps, in particular neurocutaneous perforator flaps, are also discussed in this section.
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. 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. Gluteal vy advancement perforator flap lambeau perforant gluteal. Many new developments have taken place in the field, including the use of local perforator flaps, including freestyle propeller flaps as well as. Is an sgap flap complicated for surgeons to do and for patients to recover. However, the anatomic variations decreased its popularity.
The gluteal muscles are not removed or altered during sgap flap surgery. 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. 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. 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. What are the advantages and disadvantages of perforator. Breast reconstruction perforator flap microsurgery gap sgap igap. The abdomen is the most common donor site, since excess fat and skin are usually found in this area. 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. Superior and inferior gluteal artery perforator flaps.
Gluteal turnover flap for perineal reconstruction after abdominoperineal resection. 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. Types of reconstruction surgery the gap flap incl igap. 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. 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. 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. 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. Unlike conventional tram flap reconstructions, use of our refined perforator flap techniques allow for collection of this tissue without sacrifice of underlying abdominal muscles. The ultimate technical challenge is presented with chapters on ultrathin perforator flaps and microvascular augmented superthin flaps. Natural breast reconstruction using your own tissue. The anterolateral thigh flap can provide a large skin paddle nourished by a long and largecaliber pedicle and can be harvested by twoteam work.
Although possessing all of its predecessors advantages, the sgap flap generates much less donorsite morbidity. 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. Pedicled perforator flaps are also called local perforator flaps, or island 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 superior gluteal artery perforator, or sgap, flap may be an excellent choice. The underlying gluteus maximus buttock muscle is entirely preserved with this operation. Skin and fat from the mid and upper buttock over the gluteus maximus muscle. Preoperative doppler study mapping of the perforators may be helpful in flap design and dissection. Because no muscle is used, an sgap flap is considered a musclesparing type of flap. Superior gluteal artery perforator sgap flap microsurgeon. 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. The tdap, or thoracodorsal artery perforator flap, is a newer method of reconstructing the breast using your own tissues after a lumpectomy.
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. Youll be moved to the recovery room after surgery, where hospital staff members will monitor your heart rate, body temperature, and blood pressure. Living fat is transplanted to the chest from unwanted excess from the upper hip region to give back. Breast reconstruction with gluteal artery perforator flaps diep flap. Sgap breast reconstruction what is sgap breast reconstruction. Perforator flap options for breast reconstruction include. 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. This tissue is then surgically transformed into a new breast mound. The igap flap holds several advantages over the sgap flap. It provides a flap with good projection that is very suitable for breast reconstruction, especially in young patients with a projecting contralateral breast. Patient position is either in the prone or lateral decubitus position for flap harvest. Superior gluteal artery perforator flap request pdf.
The superior gluteal artery perforator sgap flap, in particular, has become a common choice when diep flaps are not an option. Superior and inferior gluteal artery perforator flaps sgap. The superior gluteal artery perforator flap for reconstruction of sacral. The book outlines techniques for flap harvest, from the most basic to the highly advanced. 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. The site of that donor tissue depends on the end result desired by the patient and the unique anatomy of that patient. 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. 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. 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. Flap surgery diep, pap, siea, sgap, and icap flaps. Allen at the th international course on perforator flaps in mexico city. This book is an essential authoritative guide for plastic surgeons interested in making perforator flap reconstruction part of their practice.
Sgap is listed in the worlds largest and most authoritative dictionary database of abbreviations and acronyms the free dictionary. 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. Does a flap reconstruction, such as tug or sgap, go under. 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. Sgap flaps have particular nuances but they are no less complicated then the. 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. Indications for use are multiple, spanning locoregional use as a pedicled flap to freetissue transfer in breast. Perforator flaps for breast reconstruction ebook www. View media gallery before and after delayed bilateral reconstruction with superior. Each book has a full description and a direct link to amazon for the download. The largest soleus perforator flap was 15 x 9 cm, and the largest peroneal perforator flap was 9 x 4 cm. 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. A direct defatting of the sgap flap can be safely done away from the surrounding area where the perforator enters the flap.
This flap procedure is fairly rare and is for patients who dont have other options. 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. Sgap flap procedure center breast reconstruction paterson. 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. Breast reconstruction free flaps statpearls ncbi bookshelf.
Many of the contributors to perforator flaps for breast reconstruction have pioneered the procedures presented in their respective chapters. Breast reconstruction with flap surgery mayo clinic. Description, classification, and nomenclature of perforator flaps. Superior gluteal artery perforator flap an overview. This is usually done in selected cases, and is typically used for augmenting the volume or perfecting the contour of alreadyreconstructed breasts. 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. Tissue can be harvested from each buttock for symmetrical results. Breast reconstruction with flap surgery is a complex procedure performed by a plastic surgeon. By adapting freestyle flap concepts, such as preoperative mapping of the perforators and being familiar with retrograde perforator. Our study aimed to highlight anatomical similarities, differences, and variations in the microvascular anatomy between superior and inferior gluteal artery perforator 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. Plastic surgery perforator flaps for breast reconstruction. Sgap superior gluteal artery perforator flap procedure uses fat and skin from your upper buttock to create a new breast mound after a 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.
With this new advent of perforator flap techniques, it is the most innovative and stateoftheart. How is a superior gluteal artery perforator sgap flap. Does a flap reconstruction, such as tug or sgap, go under the. Suffix s is added if the flap is harvested based on direct septal or fasciocutaneous vessels. Feb 28, 2019 the superior gluteal artery perforator sgap flap allows for harvest of the upper glutealhip fat pad.
Living fat is transplanted to the chest from unwanted excess from the upper hip region to give back volume and shape in the newly. 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. The sgap flap is taken from the buttock and is based on the superior gluteal artery, which arises from the. Perforator flaps for breast reconstruction gives plastic surgeons the detailed instructions they need to perform these sophisticated breast. A novel technique for augmenting venous outflow in the superior. Sep 24, 2018 is an sgap flap complicated for surgeons to do and for. 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. The superior gluteal artery and venae via perforators through the gluteus maximus muscle. Septocutaneous gluteal artery perforator scgap flap for breast. Composite superior gluteal artery perforator flaps for unilateral breast reconstruction. In this lower position, the feeding vasculature emanates from the inferior gluteal artery, which passes below the piriformis muscle in. Superior gluteal artery perforator flap an overview sciencedirect. The superior gluteal artery perforator sgap flap is a useful technique for breast reconstruction.
The potential advantages of the diep flap are more significant, since loss of abdominal wall. Suffix ap artery perforator signifies a true musculocutaneous perforator flap. This perforator flap allows for the transfer of the patients own skin and. The superior and inferior gluteal artery perforators are abundant in the gluteal region. 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. B a lap flap is shown here being surgically elevated.
Thoracodorsal artery perforator tdap flap harvests upper back skin and fat to create the breasts. Dec 23, 2015 the superior gluteal artery perforator sgap flap uses tissue from the top of the buttocks to create breast tissue. 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. We were also the first to perform the bilateral simultaneous sgap in 1994, and our experience has subsequently been published. Breast sgap flap reconstruction brigham and womens hospital. Types of reconstruction surgery the gap flap incl igap, sgap. It yields a relatively long, thin and pliable skin flap and a good aesthetic result. The superior gluteal artery perforator sgap flap, in particular, has. You wont need to have any gluteal muscle cut or moved for a sgap reconstruction. 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. Before and after superior gluteal artery perforator sgap flap donor site same patient as in previous image. 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.
Breast reconstruction procedure guide sgapigap flap procedure. This procedure uses excess skin and fat from the gluteal buttock region and leaves all the gluteal muscle behind. Looking for online definition of sgap or what sgap stands for. The vessels that supply blood to the flap are isolated perforators derived from a deep vascular system through the underlying muscle or intermuscular septa. Most importantly, the donorsite morbidity is minimal. We recorded the number and location of perforators, the characteristics of the main perforator. The sgap flap has been primarily used as an alternate for breast reconstruction, and requires significant microsurgical experience to harvest. 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. 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. 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. The clinical application of anterolateral thigh flap. The superior gluteal artery perforator sgap flap uses tissue from the top of the buttocks to create breast tissue.
The sgap procedure is an advanced microsurgical technique that is used to rebuild the breast lost to mastectomy. Advantages of the sgap flap are a longer vascular pedicle and less donorsite pain and morbidity. A slight buttock lift results in the donor area with a fine line incision easily hidden within the panty line. The superior gluteal artery perforator sgap flap allows for harvest of the upper glutealhip fat pad. The patient is preoperatively marked for the flap chosen. This is usually done if patients do not have adequate skin and tissue in their. Composite superior gluteal artery perforator flaps for unilateral. In a reasonably thin person, the flap ranges from 1 2 cm in thickness. Part 1 outlines the fundamental concepts in perforator flap surgery. 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.
The evolution from the sgap superior gluteal artery perforator flap to the scgap. Mar 07, 2019 because no muscle is used, an igap flap is considered a musclesparing type of flap. This flap procedure is unlike a graft, which does not have an intact blood supply and therefore relies on growth of new blood vessels. 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. Several alternatives exist for breast cancer reconstruction with.
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. The perforator dissection proceeds through adductor magnus up until its origin at the profunda vessels. Is an sgap flap complicated for surgeons to do and for. 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. Simultaneous bilateral breast reconstruction with superior gluteal artery perforator sgap flaps. Perforator flaps represent the current stateoftheart in natural tissue breast reconstruction.
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