Chapter 4 INTRODUCTION Perforator flaps, initially applied in the field of breast reconstruction,1 are nowadays largely used in many fields of reconstruction, as a free or pedicled flap, because they provide reliable soft tissue coverage with less donor site morbidity.2 The S-GAP flap initially was popular to cover big defects in the lumbosacral region. In 1988 Allen and Tucker used this flap for the first time for breast reconstruction3 and nowadays in many clinics it is the second choice for autologous breast reconstruction after the DIEP (deep inferior epigastric perforator) flap.3,4 Various anatomical studies concerning the superior gluteal artery and the perforators of the gluteal region already have been performed:5,6,7 the abundance of perforators and the reliability of the S-GAP flap have already been confirmed in these studies. The pedicle of the standard S-GAP flap runs through the gluteus maximus muscle and has to be followed into the muscle itself. Cormack and Lamberty have described the presence of a superficial branch of the superior gluteal artery which subdivides in the plane between the gluteus maximus and medius muscle into three ramifying branches: a posterior, an intermediate and an anterior branch. Terminal branches from the anterior branch may emerge at the superolateral edge of the gluteus maximus muscle to pierce the deep fascia and supply the subcutaneous and cutaneous tissue.8 Dissection of these septal perforators, according to the ”Gent” consensus on perforator flaps,9 should be an easier alternative for an S-GAP flap. Therefore we focused our attention on these perforators running between the gluteus maximus and medius muscle. MATERIALS AND METHODS An anatomical study was performed in 6 gluteal regions of fixed cadavers of 3 adults (fixation fluid: formalin 2%, ethanol 20%, glycerine 17% in water). A parallel Color Doppler analysis was performed in 20 gluteal regions of 10 adult volunteers with a normal BMI and from 1.60 m to 1.80 m length: we used an Esaote MyLab 25 Color Doppler with a LA523, 4-13 MHz probe. 49
5. lay-out phd DEFINITIEF_digitaal2
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