Perianal Circumferential Reconstruction with Tailored Superior Gluteal Artery Perforator Flap

Reconstruction following wide excision of perianal lesion is challenging as it requires resistance to high risks of wound contamination and preservation of anal function. Here, we present a case of a unilateral superior gluteal artery perforator (SGAP) flap with an opening in the flap. A 77-year old woman was referred due to an extramammary Pagets disease encircling the anus. Wide excision was performed by the general surgeon team, which generated a circumferential perianal defect. A unilateral SGAP flap was elevated. Primary defatting was done and an opening was made at the proper location of the anus. The anal mucosa was pulled out through the hole and sutured to the flap. She was discharged without any complications. At the follow-up visit, preservation of postoperative anal functions, as well as satisfactory contour, were observed. A well-tailored unilateral SGAP flap may be a good option for reconstruction of a perianal defect encircling the anus.

Buried Superior Gluteal Artery Perforator Flap for Dead Space Coverage in the Sacral Area

Partial sacrectomy is a common treatment for sacral sarcomas, which often results in a large defect and exposed rectal wall. The defect could be covered using a gluteus maximus (GM) advancement flap. However, seroma and wound dehiscence are often observed after GM advancement flap coverage, delaying the wound healing process. We present a case of buried superior gluteal artery perforator (SGAP) flap following GM muscle splitting. An 11-year-old male patient with epithelioid sarcoma in the sacrum underwent partial sacrectomy. The sacral defect size was 9×6 cm, and the GM muscle was intact. We designed a 7×4-cm elliptically-shaped SGAP flap skin paddle, after which perforator dissection was performed underneath the GM muscle. To minimize dead space, the GM muscle was split and the flap was de-epithelized and advanced to the posterior rectal wall. There were no wound complications during admission and the patient was discharged on postoperative day 16. No atrophy of the flap was found on postoperative magnetic resonance imaging, either. This case demonstrates that using a buried SGAP flap for covering dead space could be a good surgical method to cover wide sacral defects.

Long-term follow-up of superior gluteal artery perforator flap closure of large myelomeningoceles

OBJECTIVE Large myelomeningocele defects and poor surrounding tissue quality make some defects particularly difficult to close primarily. This paper describes the superior gluteal artery perforator (SGAP) flap technique for defect closure and long-term clinical outcomes. METHODS The technique for closing a myelomeningocele with an SGAP flap is described. A retrospective chart review was performed on a cohort of 11 patients who underwent closure in this manner. RESULTS Between 1999 and 2015, 271 myelomeningoceles were closed, 11 of which were SGAP flap closures. The mean defect size was 5.5 × 7.2 cm. All patients underwent ventriculoperitoneal shunting. There were no cases of CSF infection. Five patients had minor wound issues (small dehiscence or eschar formation) that healed satisfactorily. Two patients had soft-tissue wound infections and required multiple revisions; one patient had multiple severe developmental abnormalities, and the other patient's flap had healed with a thick underlying fat pad 4 months postoperatively. No patients had significant surgical site pain on long-term follow-up. CONCLUSIONS The SGAP flap technique achieves tension-free closure with vascularized, fat-bearing full-thickness skin. It is useful for closure of large, complex defects, is not associated with chronic pain, and carries a morbidity risk that is comparable to other complex myelomeningocele closure techniques.