Superior gluteal artery perforator flap: A reliable method for sacral pressure ulcer reconstruction

Khurram, Mohammed Fahud; Khan, Arshad Hafeez; Ahmad, Imran; Nanda, Major General H. S.; Masoodi, Zulqarnain

doi:10.12968/jowc.2013.22.12.699

Cited by 9 publications

(11 citation statements)

References 21 publications

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“…In the current study, we did not skeletonize the perforator vessel for any of the flaps. In agreement with that, Khurram et al, [11] reported that full perforator skeletonization increased the risk of perforator twist, kink or injury, resulting in complications like vasospasm, blood flow blockage and eventually total flap loss. Koshima et al, approved the same concept of flap safety, while Verpaele et al, opposed it and recommended the need for full vessel skeletonization [17].…”

Section: Discussionsupporting

confidence: 87%

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Evaluation of Gluteal Artery Perforator Flaps in Reconstruction of Gluteal Pressure (Decubitus) Ulcers

Abdelazeem

Mayhoob

Naggar

et al. 2022

The Egyptian Journal of Plastic and Reconstructive Surgery

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Background: Pressure ulcer reconstruction remains a great challenge for plastic surgeons because of their high postoperative complication and recurrence rates. Commonly these ulcers are reconstructed with random pattern flaps or myocutaneous flaps. Gluteal artery perforator flaps have evolved in the last few decades and became popular in reconstructing pressure ulcers in the gluteal region because they preserve the gluteal muscle, allowing for revision in cases of recurrence.Objective: To evaluate the use of gluteal artery perforator flaps in reconstructing pressure ulcers of the gluteal region as regards aesthetic outcome, postoperative complications and patients' psychological satisfaction.Patients and Methods: Our study was conducted on 15 patients presented with grade IV pressure ulcers in the gluteal region, in which their ulcers were reconstructed with gluteal artery perforator flaps.Results: Twelve (80%) patients healed eventually without major complications. Two (13.3%) patients had wound edge dehiscence, and only one (6.7%) patient had a donor site wide scar. Patients were evaluated as regards aesthetic outcomes and patients' psychological satisfaction, and the overall results were satisfactory. Conclusion:The superior and inferior gluteal artery perforator flaps, with their safe anatomical basis, less morbidity and versatility in designs, are reliable and effective alternatives in reconstructing pressure ulcers of the gluteal region.

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Section: Discussionsupporting

confidence: 87%

“…In our study, most of the studied patients (80%) were paraplegic, while some (20%) were ambulatory. Khurram et al, [11] agreed with us and reported 73.3% of their patients were paraplegic.…”

Section: Discussionsupporting

confidence: 81%

Evaluation of Gluteal Artery Perforator Flaps in Reconstruction of Gluteal Pressure (Decubitus) Ulcers

Abdelazeem

Mayhoob

Naggar

et al. 2022

The Egyptian Journal of Plastic and Reconstructive Surgery

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“…Thus, perforator flaps have become many centers' preferred reconstructive method for sacral pressure sores. Although the reliability of superior gluteal artery, inferior gluteal artery, and lateral sacral artery perforator flaps in sacral reconstruction were shown in various studies, perforator flaps have some drawbacks, especially in large sacral pressure ulcers (Coskunfirat & Özgentas, 2004; Durgun & Bas, 2019; Khurram et al, 2013; Seyhan et al, 2008; Ulusoy et al, 2001). Large defects can be closed by planning contralateral flaps or truly dissected perforator flaps with a high rotation arc or multilobed flaps.…”

Section: Discussionmentioning

confidence: 99%

The use of mathematically standardized bilobed design perforator flaps for coverage of sacral pressure ulcers

et al. 2022

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Background: Sacral pressure ulcer reconstruction is frequently applied in plastic surgery practice. Although perforator flaps are frequently used, recurrence is not uncommon in patients. For this reason, using the as little area as possible during the reconstruction is vital. Therefore, we aimed to describe a mathematically standardized bilobed perforator flap design for sacral pressure ulcer reconstruction with a certain proportion and angle relation between limbs.Methods: A total of 17 patients (5 female/12 male)were included in this report. The mean age of the patients was 50.4 years (Ranging from 32 to 79 years). The patients with grade 3-4 sacral pressure ulcers were included in the report. The patients have grade 1-2 sacral ulcers or the other areas of pressure ulcer excluded. The size of the defects ranged from 8 Â 14 cm to 5 x 16 cm. For ulcers in the sacral region, we used bilobed flaps that we mathematically standardized. The length of the first limb of the flap was planned 90 vertically oriented according to the distance between the perforator zone to the distal lateral border of the defect. The width of the first limb was kept equal to the length of the defect. The orientation of the second limb of the flap was designed 90 degrees horizontally according to the first limb. Therefore, the lengths of second limbs were calculated as half of the first limb's width, and the widths of second limbs were calculated as 3 /4 width of the first limb's width.Results: A total of 10 flaps were elevated based on superior gluteal artery perforators, and seven flaps were nourished by inferior gluteal artery perforators. The mean size of the first limb of the flaps was 14.7 Â 7.2 cm (Ranging from 8 to 20 Â 6 to 13 cm). The mean size of the second limb of the flaps was 6.7 Â 5.3 cm (Ranging from 5 to 12 Â 4 to 8 cm). The mean size of defects was 10.5 Â 7.3 cm (Ranging from 8 to 14 Â 5 to 16). The mean rotation angle was 91.7 (ranging from 90 to 100). In the early postoperative period, the hematoma was detected in three patients and evacuated in one patient, resulting in wound separation. Tip necrosis was seen in a patient that was healed by wound care. No total flap loss was encountered. No late-term recurrence was seen during the follow-up. The mean follow-up time was 13.1 months (Ranging from 4 to 24 months). Conclusion:Unilateral standardized bilobed perforator can reliably be preferred in medium to large size sacral pressure ulcer defects.

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“…Once deep tissue infection is noted, in-hospital care, along with surgical interventions, 2 of 8 is beneficial for patients. Several different kinds of flaps have been introduced over the years to reconstruct sacral defects, such as local flaps, V-Y advancement fasciocutaneous flaps, gluteus maximum muscle-based flaps, inferior gluteal artery perforator flaps, and superior gluteal artery perforator (SGAP) flaps [1]. Reliable perforators are the most important factors for a successful perforator-based flaps reconstruction [2].…”

Section: Introductionmentioning

confidence: 99%

“…Thus, an accurate preoperative mapping of the perforators is essential for the safe planning of propeller flaps. To date, various methods have been reported: (1) handheld acoustic Doppler sonography (ADS), (2) color duplex sonography, (3) perforator computed tomographic angiography (P-CTA), (4) magnetic resonance angiography, and (5) indocyanine green fluorescence nearinfrared angiography (ICGFA) [3,4]. Out of these ways of mapping perforators, the golden standards are perforator computed tomographic angiography (P-CTA) and the magnetic resonance angiograph.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Detection of Superior Gluteal Artery Perforator by Indocyanine Green Fluorescence Near-Infrared ANGIOGRAPHY and Handheld Acoustic Doppler Sonography for Reconstruction of Sacral Pressure Injury

Liu

Chen

et al. 2022

JPM

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Aims: Pressure injury is a gradually increasing disease in the aging society. The reconstruction of a pressure ulcer requires a patient and surgical technique. The patients were exposed to the radiation risk under other ways of detection of perforators such as computed tomographic angiography and magnetic resonance angiography. Here, we compared two radiation-free methods of a superior gluteal artery perforator (SGAP), flap harvesting and anchoring. One is the traditional method of detecting only handheld acoustic Doppler sonography (ADS) (Group 1). The other involves the assistance of intraoperative indocyanine green fluorescent near-infrared angiography (ICGFA) and handheld ADS (Group 2). Materials and Methods: This is a single-center, retrospective, observational study that included patients with sacral pressure injury grades III and IV, who had undergone reconstructive surgery with an SGAP flap between January 2019 and January 2021. Two detection methods were used intraoperatively. The main outcome measures included the operative time, estimated blood loss, major perforator detection numbers, wound condition, and incidence of complications. Results: Sixteen patients underwent an SGAP flap reconstruction. All patients were diagnosed with grade III to IV sacral pressure injury after a series of examinations. Group 1 included 8 patients with a mean operative time of 91 min, and the mean estimated blood loss was 50 mL. The mean number of perforators was 4. Postoperative complications included one wound infection in one case and wound edge dehiscence in one case. No mortality was associated with this procedure. The mean total hospital stay was 16 days. Group 2 included 8 patients with a mean operative time of 107.5 min, and the mean estimated blood loss was 50 mL. The mean number of perforators was 5. Postoperative complications included one wound infection. No mortality was associated with this procedure. The mean total hospital stay was 13 days. Conclusions: The combination of detection of the SGAP by ICGFA and handheld ADS for the reconstruction of a sacral pressure injury provides a more accurate method and provides the advantage of being radiation-free.

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Superior gluteal artery perforator flap: A reliable method for sacral pressure ulcer reconstruction

Abstract: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.

Cited by 9 publications

References 21 publications

Evaluation of Gluteal Artery Perforator Flaps in Reconstruction of Gluteal Pressure (Decubitus) Ulcers

Evaluation of Gluteal Artery Perforator Flaps in Reconstruction of Gluteal Pressure (Decubitus) Ulcers

The use of mathematically standardized bilobed design perforator flaps for coverage of sacral pressure ulcers

Comparison of Detection of Superior Gluteal Artery Perforator by Indocyanine Green Fluorescence Near-Infrared ANGIOGRAPHY and Handheld Acoustic Doppler Sonography for Reconstruction of Sacral Pressure Injury

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