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The Microvascular Anatomy of Superior and Inferior Gluteal Artery Perforator (SGAP and IGAP) Flaps: A Fresh Cadaveric Study and Clinical Implications

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Abstract

Background

Our study aimed to highlight anatomical similarities, differences, and variations in the microvascular anatomy between superior and inferior gluteal artery perforator (SGAP and IGAP) flaps.

Method

Thirty gluteal flaps (15 SGAP and 15 IGAP) were studied on 22 adult fresh cadavers. We recorded the number and location of perforators, the characteristics of the main perforator (course, length, and diameter at the level of division at the greater sciatic foramen), and the anatomical variations of the submuscular venous plexus.

Results

The mean number of perforators was similar in both flaps (n = 7). We found a statistically significant difference in the total length of the vascular pedicle between SGAP (mean = 9.80 cm) and IGAP (mean = 13.36 cm) flaps, which correlated strongly with the difference in the intramuscular length (mean difference = 3.40 cm) of the perforator. There was no statistically significant difference in the diameter of the superior and inferior gluteal vessels at the point of pedicle division. The complex submuscular venous plexus, which is typically found on SGAP flaps deep to the sacral fascia, was never encountered on IGAP flaps. Perforators originating from the inferior gluteal artery were found on the lower half of five superior gluteal flaps. These were dominant perforators in two cases. We also report a rare anatomical communication between superior and inferior gluteal vessels deep to the piriformis muscle and a case of atheromatous disease of the inferior gluteal artery.

Conclusion

Our findings are highly relevant to clinical practice and contribute to the understanding of the vascular anatomy of SGAP and IGAP flaps and the successful use of these challenging flaps.

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Acknowledgments

We are grateful to the mortuary technician, Dimitris Mourlas, and the entire staff of the Department of Forensic Medicine for their help in facilitating our study. We also thank the statistician, George Katsabouris, for performing the statistical analysis.

Conflict of interest

The authors have no conflicts of interest to declare.

Author information

Authors and Affiliations

  1. Department of Plastic Surgery, Athens Medical School, National Kapodistrian University of Athens, Goudi, Athens, Greece

    Anthi Georgantopoulou & Othon Papadopoulos

  2. Department of Forensic Medicine, Athens Medical School, National Kapodistrian University of Athens, Goudi, Athens, Greece

    Stavroula Papadodima, Dimitrios Vlachodimitropoulos, Nikolaos Goutas & Chara Spiliopoulou

Authors
  1. Anthi Georgantopoulou
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  2. Stavroula Papadodima
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  3. Dimitrios Vlachodimitropoulos
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  4. Nikolaos Goutas
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  5. Chara Spiliopoulou
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  6. Othon Papadopoulos
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Correspondence to Anthi Georgantopoulou.

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Georgantopoulou, A., Papadodima, S., Vlachodimitropoulos, D. et al. The Microvascular Anatomy of Superior and Inferior Gluteal Artery Perforator (SGAP and IGAP) Flaps: A Fresh Cadaveric Study and Clinical Implications. Aesth Plast Surg 38, 1156–1163 (2014). https://doi.org/10.1007/s00266-014-0398-z

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  • DOI: https://doi.org/10.1007/s00266-014-0398-z

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