Plastic Surgery Research Council
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PSRC 60th Annual Meeting

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An Alternative to the SGAP Flap in Autologous Breast Reconstruction: The Gluteal Upper Lateral Flap (GULF)
Alexis Laungani, MD, Nirusha Lachman, Ph.D., Michel Saint-Cyr, MD, FRCS(C).
Mayo Clinic, Rochester, MN, USA.

Background: Many flaps have been described in autologous breast reconstruction, among which include; DIEP, SGAP/IGAP, LD, TUG and PAP flaps. Nevertheless, depending on body habitus or history of previous surgery, some of these flap donor sites may not be possible. The ascending branch of the lateral circumflex femoral artery (LCFA) provides vascularity to the upper lateral thigh and overlaps with the perforasome of the SGAP flap.
Purpose: The purpose of this study was to investigate the feasibility of using the upper lateral gluteal tissue as a potential flap donor site for autologous breast reconstruction.
Methodology: An anatomical study was performed using 6 fresh cadavers acquired at the department of anatomy at Mayo Clinic, Rochester, Minnesota. Two flaps were harvested from each cadaver for a total of 12 flaps. Two flaps were injected with red latex at the level of the profunda femoris artery for the purpose of gross anatomy description in situ. Ten flaps were harvested, cannulated with a 24 Gauge catheter and flushed with warm saline. A dilute methylene blue solution was infiltrated into the flap to identify vascular leaks, which were ligated. The flaps were then injected with Omnipaque 180 and scanned through a 64-slices CT-Scanner (Siemens). Analysis included a 3D reconstruction and assessment of flap vascularity. All donor sites were closed primarily. A retrospective study of 50 CT-scans was also performed to characterize perforator course, and vascular anatomy relative to source artery and perforator entrance into the flap.
Results: Based on our CT-scan study, we have constantly found a perforator artery and vein that are the cutaneous terminal branches of the ascending branch of LCFA (aLCFA). The aLCFA coursed towards the greater trochanter and passed underneath the rectus femoris and tensor fascia late muscles (Figures 1-4). The anatomical findings confirmed the CT-scan radiologic study and showed an average pedicle length of 8cm. The perforasome (perforator vascular territory) related to this perforator was defined during the injection studies and extended from the greater trochanter to the upper posterior aspect of the thigh and buttock.
Conclusion: We describe a flap that could become a good alternative to the SGAP flap for breast reconstruction. This potential new flap option presents many advantages. These include a less tedious pedicle dissection, conservation of the buttock contour and a dissection in a supine position, thus allowing a two-team approach in autologous breast reconstruction.




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