RECONSTRUCTIVE
The Superior and Inferior Gluteal Artery
Perforator Flaps
Reza Ahmadzadeh, B.Sc.
Leonard Bergeron, M.D.,
C.M., M.Sc.
Maolin Tang, M.D.
Steven F. Morris, M.D., M.Sc.
Halifax, Nova Scotia, Canada
Background: Perforator flaps have allowed reconstruction of soft-tissue defects
throughout the body. The superior and inferior gluteal artery perforator flaps
have been used clinically, yet the published anatomical studies describing the
blood supply to the gluteal skin are inadequate. This study comprehensively
evaluated the anatomical basis of these flaps to present anatomical landmarks
to facilitate flap dissection.
Methods: In six fresh cadavers, the integument of the gluteal region was dis-
sected. Cutaneous perforators of the superior and inferior gluteal arteries were
identified. Their course, size, location, and type (septocutaneous versus mus-
culocutaneous) were recorded based on dissection, angiography, and photog-
raphy. The surface areas of cutaneous territories and perforator zones were
measured and calculated.
Results: The average number of superior and inferior cutaneous perforators
greater than or equal to 0.5 mm in the gluteal region was 5 2 and 8 4,
respectively, with all of the superior and 99 percent of the inferior gluteal artery
perforators being musculocutaneous. Their average perforator internal diam-
eter was 0.6 0.1 mm. The average superior and inferior gluteal artery cuta-
neous vascular territory was 69 56 cm
2
and 177 38 cm
2
, respectively. The
superior gluteal perforators were found adjacent to the medial two-thirds of a
line drawn from the posterior superior iliac spine to the greater trochanter. The
inferior gluteal artery perforators were concentrated along a line in the middle
third of the gluteal region above the gluteal crease.
Conclusion: The reliable size and consistency of the superior and inferior
gluteal artery perforators allow the use of pedicled and free superior and inferior
gluteal artery perforator flaps in a variety of clinical situations. (Plast. Reconstr.
Surg. 120: 1551, 2007.)
O
ne of the main goals in reconstructive
surgery of soft-tissue defects is to replace
“like with like.” During the evolution of
flap design and transfer over the past 50 years,
surgeons have gradually improved the results of
reconstructive surgical procedures by selecting
the best flap for a specific reconstructive chal-
lenge. Perforator flaps have become well accepted
and are useful alternatives to historical reconstruc-
tive techniques.
1
The musculocutaneous superior
and inferior gluteal artery flaps have been previ-
ously described and may have a role in certain
procedures. However, the sacrifice of muscle in the
region and the potentially difficult dissection have
limited their acceptance. The superior gluteal ar-
tery perforator (SGAP) and inferior gluteal artery
perforator (IGAP) flaps have been well described
clinically and are reliable flap procedures. A more
detailed description of the vascular anatomy will
aid surgeons in the customized design of perfora-
tor flaps in this region.
2
Fujino et al.
3
first used the gluteal region as a
donor site in 1975. Since then, gluteal flaps based
on the superior gluteal artery have advanced, as
shown in the works of Blondeel
4
and Allen and
Tucker.
5
The inferior gluteal artery free flap was
first reported by Le-Quang
6
in 1979 and later was
used as a perforator flap by Higgins et al.
7
in 2002.
Potential donor sites for breast reconstruction
are few. In the thin patient, the buttocks region
offers a substantial amount of soft tissue that can
be microsurgically transferred. Clinical works
have documented the use of the superior gluteal
From the Departments of Anatomy and Neurobiology and
Surgery, Dalhousie University.
Received for publication December 13, 2005; accepted June
7, 2006.
Presented at the 51st Annual Meeting of the Research Council
of Plastic Surgery, in Dana Beach, California, May 20, 2006.
Copyright ©2007 by the American Society of Plastic Surgeons
DOI: 10.1097/01.prs.0000282098.61498.ee
www.PRSJournal.com 1551