Τομέας ΚλινικοεργαστηριακόςLibrary of the School of Health Sciences
Ο. Καθηγητής Αλκιβιάδης Κωστάκης, Ο. Καθηγητής Όθων Παπαδόπουλος, Καθηγήτρια Χαρά Σπηλιοπούλου
Ανατομική μελέτη των κρημνών διατιτρωσών κλάδων άνω και κάτω γλουτιαίων αγγείων
Introduction: Our study aims to highlight anatomical similarities, differences
and variations in the microvascular anatomy between SGAP and IGAP flaps.
Method: Thirty gluteal flaps (15 SGAP and 15 IGAP) were dissected on 22 adult
fresh cadavers. We recorded the number and location of perforators, the
characteristics of the main perforator (course, intramuscular/total 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 (seven). We
found a statistically significant difference in the total length of the
vascular pedicle between SGAP (mean:9.80cm) and IGAP (mean:13.36cm) flaps,
which correlated strongly and was due to the difference in the intramuscular
length of the perforator (mean difference of intramuscular length: 3.40cm).
There was no statistically significant difference in the diameter of superior
and inferior gluteal vessels at the point of pedicle division. Five superior
gluteal flaps were found, on their lower half, to have perforators originating
from the inferior gluteal artery. These were dominant perforators in two cases.
In both flaps, there was significant variability in the thickness of sacral
fascia and the amount of fibrofatty tissue deep to it. The close proximity of
the inferior gluteal vessels to the sciatic nerve and the posterior cutaneous
nerve of the thigh is demonstrated. The complex submuscular venous plexus with
confluence of veins, which is typically found on SGAP flaps deep to the sacral
fascia, is never encountered on IGAP flaps. We also report a rare anatomical
communication between superior and inferior gluteal vessels deep to 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 complex and variable vascular anatomy of
these challenging flaps.
Microvascular anatomy, Gluteal perforator flaps, SGAP flap, IGAP flap, Superior and inferior gluteal αrtery perforator flaps