Gluteal Thigh Flap for Perineal Reconstruction



Gluteal Thigh Flap for Perineal Reconstruction


David Gerth

Christopher J. Salgado





ANATOMY (FIG 1)



  • Blood supply: Descending branch of inferior gluteal artery1



    • Terminal branch of the internal iliac artery.


    • Course: exits the pelvis through the infrapiriform aperture


    • Supplies the lower aspect of the gluteus maximus muscle and overlying skin through musculocutaneous perforators2



      • These perforators combine with branches of the circumflex femoral arteries and obturator artery to create the cruciate anastomosis.



        • This anastomosis allows the posterior thigh to be adequately perfused even in the case of an absent inferior gluteal artery.






          FIG 1 • Relevant surgical anatomy for the gluteal thigh flap. Note the relationship of the posterior femoral cutaneous nerve to the inferior gluteal artery. This classic relationship is not constant, however.


        • Recent study has shown that cutaneous branches supplying the distal gluteal and proximal posterior thigh can be more regularly identified.


        • 108 of 118 specimens had cutaneous branches derived from the descending branch of the inferior gluteal artery. Ten cases derived from medial or lateral circumflex femoral artery or from the profunda femoris.3


    • Pedicle is usually spared during radical pelvic ablations.


    • Pedicle is usually outside the area affected by pelvic radiation.4


  • Venous drainage



    • Redundant



      • Deep system



        • Venae comitantes of inferior gluteal artery


        • Venae comitantes of deep femoral perforators


      • Superficial venous system


    • Due to substantial drainage, venous congestion rarely occurs.5


  • Innervation: posterior femoral cutaneous nerves (S1-S3)



    • Many fascicles exit the sciatic foramen along with the inferior gluteal artery.


    • Fascicles converge to form a common trunk with the descending branch of the inferior gluteal artery.4


PATHOGENESIS



  • Most common: Malignancy


  • Infection


  • Traumatic injury6


PATIENT HISTORY AND PHYSICAL FINDINGS



IMAGING



  • No preoperative imaging is necessary.


  • Viability of the flap can be assessed intraoperatively via quantitative fluoroangiography (FIG 2).


SURGICAL MANAGEMENT

Dec 6, 2019 | Posted by in Reconstructive microsurgery | Comments Off on Gluteal Thigh Flap for Perineal Reconstruction
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