Gluteal flaps as a secondary option for autologous breast reconstruction

• Do you evaluate patients for gluteal perforator flaps if they are not candidates for a DIEP flap?
• Rationale for preference of SGAP flap over IGAP flap?
• Can you describe your pre-operative marking for this flap?
• Do you operate in a lateral decubitus position for unilateral construction?
• Do you find that you have enough pedicle length or do you ever need to harvest arterial or vein grafts? Is the IGAP pedicle typically longer? Will you take the flap off a single perforator?
• Do you go to the 4th rib for recipient vessels for a better size match?
• There have been previous studies showing equivalent complication profiles to DIEP flaps, but in your experience, have you noticed any differences in terms of rates of fat necrosis or donor site wound dehiscence?

Gluteal based flaps in the context of reconstruction of pressure sores. Flaps based off gluteal perforators have been described for reconstruction of sacral, ischial, and trochanteric ulcers.

• For large gluteal rotational or advancement flaps, are you dopplering out and identifying a perforator during the case?
• What is your preference for rotating gluteal tissue vs using a posterior thigh flap for ischial pressure ulcer reconstruction?
• In paraplegic patients, do you take fascia or muscle?

You have also published a case report using a pedicled SGAP flap for reconstruction of a lumbar spinal defect, which was a great option that I don’t think we see very often.

• Do you always get pre-operative CTA for these cases?
• In the case you presented, there was no concern for venous congestion but is this often a concern when rotating the pedicle for inset?
• You mentioned in the case report that you were prepared to convert to a free flap. Is this something you have had to do in the past?
• Any tips for dissection? How much do you have to dissect through the muscle?

Bonus question:

What are some tips you could give residents, fellows, or junior faculty for how to improve efficiency in the OR for micro cases?