Septocutaneous gluteal artery perforator (sc-GAP) fl ap for breast reconstruction: how we do it The superior gluteal artery The short and large superior gluteal artery (SGA) is a continuation of the posterior trunk of the internal iliac artery and runs posteriorly between the lumbosacral trunk and the fi rst sacral ventral ramus. Within the lesser pelvis it supplies the piriformis and obturator internus muscles and is a nutritient artery for the hip bone. It leaves the greater sciatic foramen cranial to the piriformis muscle and immediately ramifi es into (1) superfi cial and (2) deep branches (fi g 6.3). The superfi cial branch of the SGA enters the septal plane between the gluteus medius and gluteus maximus muscles. From that plane there are three clinical important ramifi cations: SUPERFICIAL 1 4 5 6 3 DISTAL CRANIAL 11 12 2 9 8 10 7 DEEP 1. skin and subcutis 2. superfi cial branch of SGA SGA 3. muscular branch 4. m. gluteus maximus 5. musculocutaneous perforator 6. sc perforator 7. deep branch of SGA 8. m. gluteus medius 9. musculocutaneous perforator 10. muscular branch 11. musculocutaneous perforator 12. thick fascia on m. gluteus medius and cranial border of m. gluteus maximus Figure 6.3 Schematic illustration of the course of perforators and muscular branches originating from the superfi cial and the deep branch of the superior gluteal artery. Illustration of Greet Mommen, www.greetmommen.be. 90
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