Introducing the sc-GAP Flap: A New Approach to Microsurgical Breast Reconstruction Figure 5.2 Preoperative markings for the septocutaneous gluteal artery perforator flap (right) consist of an elliptical skin island centered on one perforator within the ipsilateral gluteal region, with marks cephalad to the margin of the gluteus maximus muscle. The design of the septocutaneous gluteal artery perforator skin island is more cephalad and lateral than that used in a conventional musculocutaneous superior gluteal artery perforator flap (left). In cases of primary reconstruction, the oncologic surgeon performs the mastectomy, after which the reconstructive surgeon prepares the recipient vessels. The patient is then flipped to the prone position to elevate the gluteal artery perforator flap. In cases of secondary reconstruction, patients are placed in the prone position at the start of the procedure for flap harvest. Dissection starts from the cephalad side of the skin island and continues caudally until the margin of the gluteus maximus muscle is identified and the fascia incised (Fig. 5.3). The key point of the dissection is the identification of the superior margin of the gluteus maximus. Once the superior edge of the gluteus maximus is identified and the fascia incised, the septocutaneous perforator(s) may be palpated at the inferior edge of the gluteus maximus. The plane between the gluteus maximus and medius muscles is very loose, and if the surgeon puts his or her finger in this plane, it can be moved and the pulsation of the perforators running in the same plane can be felt. A small cuff of fascia around the perforator can be included in the flap (Fig. 5.4). The gluteus maximus and gluteus medius are then separated to expose the septocutaneous perforator (Fig. 5.5). If more than one septo- cutaneous perforator exists, all of them may be preserved if possible; otherwise, the most lateral one may be preserved and dissected under- neath the gluteus maximus to the origin of the superior gluteal artery (Figs. 5.6 and 5.7). Once the vessels are identified and the flap is harvested, the donor site 68
5. lay-out phd DEFINITIEF_digitaal2
To see the actual publication please follow the link above