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Septocutaneous gluteal artery perforator (sc-GAP) flap for breast reconstruction: how we do it ABSTRACT In this chapter we would like to describe the sc-GAP procedure as performed in our institution. The procedure is described from the preoperative imaging to the postoperative period. Anatomy The anatomy of the gluteal region will be described. Introduction We would like to start with an introduction about the history of the S-GAP (superior gluteal artery perforator) flap and hisits evolution in the sc-GAP (septocutaneous gluteal artery perforator) flap. The concept of the septocutaneous perforator will also be explained. Preoperative imaging Preoperative the patients undergo an MRA (magnetic resonance angiography) and an ultrasound exam. MRA: our MRA protocol is reported. The method to identify septo- cutaneous perforators and the preoperative markings are reported. Ultrasound: the septum between the gluteus maximus and medius and the perforator to be chosen are identified with ultrasound the day before the operation identified with ultrasound. Preoperative landmarks The drawing of the patient and the difference between the standard S-GAP and the sc-GAP are reported. Surgical technique The position of the patient during the operation, approach to unilateral or bilateral cases, and harvesting of the flap step by step, are reported. Pitfalls Tips and tricks to perform the flap are described. 82


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