Long-term follow-up of superior gluteal artery perforator flap closure of large myelomeningoceles

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Large myelomeningocele defects and poor surrounding tissue quality make some defects particularly difficult to close primarily. This paper describes the superior gluteal artery perforator (SGAP) flap technique for defect closure and long-term clinical outcomes.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The technique for closing a myelomeningocele with an SGAP flap is described. A retrospective chart review was performed on a cohort of 11 patients who underwent closure in this manner.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Between 1999 and 2015, 271 myelomeningoceles were closed, 11 of which were SGAP flap closures. The mean defect size was 5.5 × 7.2 cm. All patients underwent ventriculoperitoneal shunting. There were no cases of CSF infection. Five patients had minor wound issues (small dehiscence or eschar formation) that healed satisfactorily. Two patients had soft-tissue wound infections and required multiple revisions; one patient had multiple severe developmental abnormalities, and the other patient's flap had healed with a thick underlying fat pad 4 months postoperatively. No patients had significant surgical site pain on long-term follow-up.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>The SGAP flap technique achieves tension-free closure with vascularized, fat-bearing full-thickness skin. It is useful for closure of large, complex defects, is not associated with chronic pain, and carries a morbidity risk that is comparable to other complex myelomeningocele closure techniques.</jats:p></jats:sec>

Soft tissue coverage of a total gluteal defect with a combination of perforator‐based flaps: A case report

“…It can be used locally, both as advancement and as propeller flap, for pressure sore coverage but it has been described also for other purposes. These include lumbar spine defects (Daly, Ortiz, Shin, Bojovic, & Eberlin, 2019; Whittemore, Swift, Weprin, & Duffy, 2017), perineal defects after abdominoperineal resection (Ayestaray & Proske, 2015), and, as a free flap, for autologous breast reconstruction (Hunter, Moody, Luan, Nazerali, & Lee, 2016).…”

A Study of the Course, Branching Pattern and Dimensions of the Superior and Inferior Glutealarteries

“…This observation has great clinical relevance in perforator ap surgery where the use of customized perforator aps from the gluteal region have become a very popular method for breast reconstruction [5] and repair of defects of the perineum [6]. A perforator ap consists of the skin and underlying tissue that is perfused by an isolated artery whose branches penetrate into deeper structures within the ap [2]. The success of such perforator aps is based on the adequacy of the arterial supply of the branches of SG [6] and IG [11].…”

Comparison of dorsal intercostal artery perforator propeller flaps and bilateral rotation flaps in reconstruction of myelomeningocele defects

“…Other reasons for wound dehiscence at the flap recipient site may be caused by wound infection or closure of the wound under excessive tension. Partial patient whose myelomeningocele defect was reconstructed with a superior gluteal artery perforator flap exhibited clinical manifestations related to tethered cord (18).…”