TY - JOUR
T1 - Ten-year experience of superior gluteal artery perforator flap for reconstruction of sacral defects in tri-service general hospital
AU - Lin, Chin-Ta
AU - Dai, Niann-Tzyy
AU - Chang, Shun-Cheng
AU - Chen, Shyi-Gen
AU - Chen, Tim-Mo
AU - Wang, Hsian-Jenn
AU - Tzeng, Yuan-Sheng
N1 - Export Date: 21 March 2016
通訊地址: Tzeng, Y.-S.; Department of Surgery, Division of Plastic and Reconstructive Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; 電子郵件: [email protected]
參考文獻: Minami, R.T., Mills, R., Pardoe, R., Gluteus maximus myocutaneous flaps for repair of pressure sores (1977) Plast Reconstr Surg, 60, pp. 242-249; Parry, S.W., Mathes, S.J., Bilateral gluteus maximus myocutaneous advancement flaps: Sacral coverage for ambulatory patients (1982) Ann Plast Surg, 8, pp. 443-445; Stevenson, T.R., Pollock, R.A., Rohrich, R.J., Vanderkolk, C.A., The gluteus maximus musculocutaneous island flap: Refinements in design and application (1987) Plast Reconstr Surg, 79, pp. 761-768; Koshima, I., Moriguchi, T., Soeda, S., Kawata, S., Ohta, S., Ikeda, A., The gluteal perforator-based flap for repair of sacral pressure sores (1993) Plast Reconstr Surg, 91, pp. 678-683; Verpaele, A.M., Blondeel, P.N., van Landuyt, K., Tonnard, P.L., Decordier, B., Monstrey, S.J., The superior gluteal artery perforator flap: An additional tool in the treatment of sacral pressure sores (1999) Br J Plast Surg, 52, pp. 385-391; Shea, J.D., Pressure sores: Classification and management (1975) Clin Orthop, 112, pp. 89-100; Kierney, P.C., Engrav, L.H., Isik, F.F., Esselman, P.C., Cardenas, D.D., Rand, R.P., Results of 268 pressure sores in 158 patients managed jointly by plastic surgery and rehabilitation medicine (1998) Plast Reconstr Surg, 102, pp. 765-772; Acartürk, T.O., Parsak, C.K., Sakman, G., Demircan, O., Superior gluteal artery perforator flap in the reconstruction of pilonidal sinus (2010) J Plast Reconstr Aesthet Surg, 63, pp. 133-139; Ahmadzadeh, R., Bergeron, L., Tang, M., Morris, S.F., The superior and inferior gluteal artery perforator flaps (2007) Plast Reconstr Surg, 120, pp. 1551-1556; Coşkunfirat, O.K., Ozgentaş, H.E., Gluteal perforator flaps for coverage of pressure sores at various locations (2004) Plast Reconstr Surg, 113, pp. 2012-2017; Meltem, C., Esra, C., Hasan, F., Ali, D., The gluteal perforator-based flap in repair of pressure sores (2004) Br J Plast Surg, 57, pp. 342-347; Lee, J.T., Hsiao, H.T., Tung, K.Y., Ou, S.Y., Gluteal perforator flaps for coverage of pressure sores at various locations (2006) Plast Reconstr Surg, 117, pp. 2507-2508
PY - 2014
Y1 - 2014
N2 - Background: Despite advances in reconstruction techniques, sacral sores continue to present a challenge to the plastic surgeon. The superior gluteal artery perforator (SGAP) flap is a reliable flap that preserves the entire contralateral side as a future donor site. On the ipsilateral side, the gluteal muscle itself is preserved and all flaps based on the inferior gluteal artery are still possible. However, the dissection of the perforator is tedious and carries a risk of compromising the perforator vessels. Patients and Methods: During the period between April 2003 and March 2013, 30 patients presented to our section with sacral wounds causing by pressure sores or infected pilonidal cysts. Of a total of 30 patients, 13 were female and 17 were male. Their ages ranged from 22 to 92 years old (mean 79.8 years old). Surgical intervention was performed electively with immediate or delayed reconstruction using a SGAP flap. The characteristics of patients' age, and sex, and cause of sacral defect, co-morbidities, wound culture, flap size, perforator number, hospital stay, and outcome were reviewed. Results: For all operations, the length of the pedicle dissection will not exceed 1 cm because of the vascular anatomy of the SGAP, which lies adjacent to the sacral region. Due to short pedicle dissection, all SGAP flap were elevated around an hour. All flaps survived except two, which had partial flap necrosis and were finally treated by contralateral V-Y advancement flaps coverage. The mean follow-up period was 14.8 months (range 3-24). No flap surgery-related mortality was found. Conclusion: Perforator-based flaps have become popular in modern reconstructive surgery because of low donor site morbidity and good preservation of muscle. Our study shows that deep pedicle dissection is unnecessary when the surgery involves an accurate indicating perforator, adequate flap size design, and correct selection of flap utilization between tunnel and rotation. The advantages of this modification include a faster operation, less bleeding, and less trauma of the pedicle, which make the SGAP flaps an alternative choice for sacral sores coverage. © 2014 JMS.
AB - Background: Despite advances in reconstruction techniques, sacral sores continue to present a challenge to the plastic surgeon. The superior gluteal artery perforator (SGAP) flap is a reliable flap that preserves the entire contralateral side as a future donor site. On the ipsilateral side, the gluteal muscle itself is preserved and all flaps based on the inferior gluteal artery are still possible. However, the dissection of the perforator is tedious and carries a risk of compromising the perforator vessels. Patients and Methods: During the period between April 2003 and March 2013, 30 patients presented to our section with sacral wounds causing by pressure sores or infected pilonidal cysts. Of a total of 30 patients, 13 were female and 17 were male. Their ages ranged from 22 to 92 years old (mean 79.8 years old). Surgical intervention was performed electively with immediate or delayed reconstruction using a SGAP flap. The characteristics of patients' age, and sex, and cause of sacral defect, co-morbidities, wound culture, flap size, perforator number, hospital stay, and outcome were reviewed. Results: For all operations, the length of the pedicle dissection will not exceed 1 cm because of the vascular anatomy of the SGAP, which lies adjacent to the sacral region. Due to short pedicle dissection, all SGAP flap were elevated around an hour. All flaps survived except two, which had partial flap necrosis and were finally treated by contralateral V-Y advancement flaps coverage. The mean follow-up period was 14.8 months (range 3-24). No flap surgery-related mortality was found. Conclusion: Perforator-based flaps have become popular in modern reconstructive surgery because of low donor site morbidity and good preservation of muscle. Our study shows that deep pedicle dissection is unnecessary when the surgery involves an accurate indicating perforator, adequate flap size design, and correct selection of flap utilization between tunnel and rotation. The advantages of this modification include a faster operation, less bleeding, and less trauma of the pedicle, which make the SGAP flaps an alternative choice for sacral sores coverage. © 2014 JMS.
KW - Reconstruction
KW - Sacral sore
KW - Superior gluteal artery perforator flap
KW - Acinetobacter baumannii
KW - adult
KW - aged
KW - article
KW - Candida albicans
KW - clinical article
KW - debridement
KW - decubitus
KW - donor site
KW - Doppler flowmetry
KW - Entamoeba coli
KW - Enterococcus faecalis
KW - female
KW - gluteus maximus muscle
KW - graft necrosis
KW - human
KW - immobility
KW - male
KW - middle aged
KW - pilonidal sinus
KW - Pseudomonas aeruginosa
KW - sacral defect
KW - sacrum
KW - skin injury
KW - skin transplantation
KW - Staphylococcus aureus
KW - superior gluteal artery perforator flap
KW - very elderly
KW - wound dehiscence
KW - young adult
U2 - 10.4103/1011-4564.131895
DO - 10.4103/1011-4564.131895
M3 - Article
SN - 1011-4564
VL - 34
SP - 66
EP - 71
JO - Journal of Medical Sciences (Taiwan)
JF - Journal of Medical Sciences (Taiwan)
IS - 2
ER -