Chapter 4 CONCLUSIONS Perforators in the gluteal area running through the gluteus maximus muscle could be difficult to dissect, so they are a second choice applying a free or pedicled flap. In this study septal perforators were found running between the gluteus maximus and the gluteus medius muscle. The presence of these perforat- ors should be tested preoperatively with Color Doppler. Generally they are easier to dissect. In addition when situated laterally the arc of rotation and the pedicle length of an S-GAP flap should be improved. This could make the flap technically easier. REFERENCES 1. Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg 1994 Jan;32(1):32-38. 2. Blondeel PN, Boeckx WD, Vanderstraeten GG, et al. The fate of the oblique abdominal muscles after free TRAM flap Surgery. Br J Plast Surg 1997 Jul;50(5):315-321. 3. Allen JR, Tucker C jr. Superior gluteal artery perforator free flap for breast reconstruction. Plast Reconstr Surg 1995 Jun;95(7):1207-1212. 4. Guerra AB, Soueid N, Metzinger SE, Levine J, et al. Simultaneous bilateral breast reconstruction with superior gluteal artery perforator (S-GAP) flap. Ann Plast Surg 2004 Oct;53(4):305-310. 5. Kankaya Y, Ulusoy MG, Oruc M, Yildiz K, Kocer U, Tuccar E. Perforating arteries of the gluteal region: anatomic study. Ann Plast Surg 2006 Apr;56(4):409-412. 6. Koshima I, Moriguchi T, et al. The gluteal perforator-based flap for repair of sacral pressure sores. Plast Reconstr Surg 1993 Apr;91(4):678-683. 7. Ebraheim NA, Olexa TA, Xu R, et al. The quantitative anatomy of the superior gluteal artery and its location. Am J Orthop 1998 Jun;27(6):427-431. 8. Cormack GC, Lamberty BGH. The arterial anatomy of skin flaps, second edition. Curchill Livingstone 1994:218-222. 9. Blondeel PN, Van Landuyt KH, Monstrey SJ, Hamdi M, Matton GE, Allen RJ, Dupin C, Feller AM, Koshima I, Kostakoglu N, Wei FC. The “Gent” consensus on perforator flap terminology: preliminary definitions. Plast Reconstr Surg 2003 Oct;112(5):1378-1383. 10. Verpaele AM, Blondeel PN, Van Landuyt K, et al. The superior gluteal artery perforator flap: an additional tool in the treatment of sacral pressure sores. Br J Plast Surg 1999 Jul;52(5):385-391. 61
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