Clinical effects of superior gluteal artery perforator island flap in repair of sacral pressure ulcer / 中华烧伤杂志

Objective@#To explore the clinical effects of superior gluteal artery perforator island flap in repair of sacral pressure ulcer.@*Methods@#From May 2012 to May 2017, 20 patients with sacral pressure ulcers (14 males and 6 females, aged 27 to 67 years) were admitted to our department. According to the consensus staging system of National Pressure Ulcer Advisory Panel in 2016, 6 cases were in 3 stages, 14 cases were in 4 stages, with the area of pressure ulcers ranging from 5.0 cm×4.0 cm to 10.0 cm×8.0 cm. After debridement and vacuum sealing drainage, the superior gluteal artery perforator island flaps were used to repair the pressure wounds, with the area of flaps ranging from 6 cm×5 cm to 13 cm×8 cm. The donor sites were sutured directly. The survival of flaps after operation, the healing of wounds, and the follow-up of patients were observed.@*Results@#After surgery, flaps of 20 patients survived well without reoperation. The length of hospital stay of patients was 20 to 40 days, with an average of 25 days. Eighteen patients were followed up for 6 to 24 months, with an average of 12.2 months. The flaps were in good shape and elastic recovery. There were no complications such as seroma or hematoma in the donor sites. Both the patients and family members expressed satisfaction with the shape and texture of the flap and shape of hip.@*Conclusions@#The superior gluteal artery perforator island flap is reliable in blood supply and easy to rotate. The flap can carry a little muscle to increase the anti-infective ability. Moreover, the donor site can be directly sutured with slight damage. Thus, it is one of the good methods for repairing sacral pressure ulcers.

Dual Perforator Flap for Reconstruction of Large Sacral Defects: Superior Gluteal Artery Perforator Super-Flap with Parasacral Perforator

The superior gluteal artery perforator flap technique has increasingly been used for soft tissue defects in the sacral area following its introduction nearly 25 years ago. Advantages in covering sacral defects include muscle sparing, versatility in design, and low donor side morbidity. The bilateral superior gluteal artery perforator flap procedure is planned in cases of large sacral defects that cannot be covered with the unilateral superior gluteal artery perforator flap. Here, we report two cases of large sacral defects in which patient factors of poor general health, such as old age, pneumonia, and previous operation scar, led to use of a large unilateral superior gluteal artery perforator super-flap with parasacral perforator. The approach was utilized to reduce the operation time and prevent unpredictable flap failure due to the large flap size. Even though the parasacral perforator was included, the versatility of the large superior gluteal artery perforator flap was preserved because sufficient perforator length was acquired after adequate dissection.

Superior Gluteal Artery Pseudoaneurysm Caused by Pelvic C-Clamp Blind Application: A Case Report / 대한고관절학회지

To control such a hemorrhage, a displaced pelvic ring must be rapidly reduced and stabilized with a pelvic binder, an external fixator, or a pelvic clamp. Among them, pelvic clamps can be life-saving but pin malposition may cause vascular complications. We present a case of superior gluteal artery pseudoaneurysm caused by AO pelvic C-clamp pin malposition.

Variability of Origin of Obturator Artery and its Clinical Significance.

Background: Obturator artery is a branch of anterior division of internal iliac artery. It normally runs anteroinferiorly on the lateral wall of pelvis to the upper part of the obturator foramen and leaves the pelvis by passing through the obturator canal. On its course, the artery is accompanied by the obturator nerve and vein. It supplies the muscles of the medial compartment of the thigh. A severe and potentially lethal complication in pelvic injuries is arterial bleeding commonly involving the branches of the internal iliac artery, namely the lateral sacral, iliolumbar, obturator, vesical and inferior gluteal arteries. A sound knowledge of retro-pubic pelvic vascular anatomy is pivotal for successful performance of endoscopic procedures such as total extraperitoneal inguinal hernioplasty or laparoscopic herniorraphy. The context and purpose of the study: This study is an attempt to analyse the origin, course, distribution of obturator artery in pelvis and their clinical implication. Result: out of 60 formalin fixed pelvic halves 36.6% of the specimens, (26.67% in males and 10% in females) the origin of obturator artery was found to be normal from anterior division of internal iliac artery. About 63.63% from various other sources. Conclusion: This knowledge of variation in the origin of obturator artery is important while doing pelvic and groin surgeries requiring appropriate ligation. Such aberrant origins may be a significant source for persistent bleeding in the setting of acute trauma. Knowledge regarding the variations of obturator artery is useful during surgeries of fracture and direct or indirect inguinal, femoral and obturator hernias.

The vascular supply of hip joint and its clinical significant / Suministro vascular de la articulación de la cadera y su significado clínico

The hip joint gains its vascular supply from the superior gluteal arteries as well as from the medial and lateral circumflex femoral arteries with the first perforating artery. In gluteal trauma, the superior and inferior gluteal artery may be affected which may end with vascular insult of hip joint. The current study includes a dissection of 171 cadavers to examine the vascular supply of hip joint. In 99.3% of articular branch arises from the superior gluteal artery either directly or indirectly (95.4% or in 3.9%, respectively). In 81% of articular branch arises from the inferior gluteal artery either directly or indirectly in 78% or in 3%. In 20.3% of articular branch arises from the coexistence of sciatic artery either directly or indirectly (17.7% or in 2.6%, respectively). Infrequently, the internal pudendal artery gives articular branch in 0.4%. Further, there is no difference between male and female in hip joint supply in current study. Based on current study's result, the dominant articular branch of vascular supply of the hip joint comes from the superior gluteal artery whereas the inferior gluteal artery comes beyond due its congenital absence. The coexistence sciatic artery is a replacement artery for superior or inferior gluteal artery in case of congenital absence. Due to aneurysm of the three previous arteries after trauma, it is important to study their course and articular branches to avoid iatrogenic fault of joint vascular insult during surgical management of either true or false aneurysm.

La articulación de la cadera obtiene su suministro vascular desde las arterias glúteas superiores, así como desde las arterias circunflejas femorales lateral y medial y la primera arteria perforante. En el trauma glúteo, las arteria glúteas superior e inferior pueden verse afectadas, lo que puede terminar con una lesión vascular de la articulación de la cadera. Este estudio incluyó la disección de 171 cadáveres con el fin de examinar el suministro vascular de la articulación de la cadera. El 99,3% de las ramas articulares se originan de la arteria glútea superior, ya sea directa o indirectamente (95,4% o en 3,9%, respectivamente). En 81% de los casos, la rama articular sse origina de la arteria glútea inferior, directa o indirectamente (78% y 3%, respectivamente). El 20,3% de la rama articular se origina de la conexistencia de la arteria ciática, ya sea directa o indirectamente (17,7% y 2,6%, respectivamente), y con poca frecuencia, la arteria pudenda interna origina una rama articular (0,4%). Además, los resultados no mostraron diferencia en el suministro de articulación de la cadera entre hombres y mujeres. En base a nuestros resultados, podemos señalar que la rama articular dominante de suministro vascular de la articulación de la cadera proviene de la arteria glútea superior, mientras que la arteria glútea inferior aporta de manera escasa debido a su ausencia congénita. La coexistencia de una arteria ciática, constituye un reemplazo de las arterias glútea superior o inferior en caso de ausencia congénita. En caso de un aneurisma de alguna de las tres arterias anteriores, posterior a un trauma, resulta importante estudiar su curso y ramas articulares para evitar una lesión vascular iatrogénica conjunta durante el tratamiento quirúrgico de aneurisma de tipo verdadero o falso.

Colgajo de perforantes de la arteria glútea superior para reconstrucción de defecto en región lumbosacra: reporte de un caso / Superior gluteal artery perforator (SGAP) flap for lumbosacral reconstruction

Los defectos de tejidos blandos a nivel de región lumbosacra son comunes en la cirugía reconstructiva. El colgajo de perforantes de la arteria glútea superior (SGAP) es una herramienta muy útil para el cubrimiento de este tipo de defectos y se asocia con un menor porcentaje de efectos funcionales secundarios al respetar el músculo glúteo mayor y su inervación. El objetivo de este artículo es realizar el reporte de un caso describiendo las indicaciones, la técnica quirúrgica y el resultado postoperatorio de esta intervención en un paciente con un defecto de cubrimiento a nivel lumbosacro secundario a una resección oncológica.

The soft tissue defects at the level of lumbosacral region are common in reconstructive surgery. Superior gluteal artery (SGAP) perforator flap is a very useful tool for covering such defects and is associated with a lower percentage of secondary functional effects as regards the gluteus maximus muscle and its innervation. The objective of this paper is report a case, describing the indications, surgical technique, and postoperative outcome of this intervention in a patient with a soft tissue defect in lumbosacral region secondary to an oncological resection.

Superior Gluteal Artery Injury during Percutaneous Iliosacral Screw Fixation: A Case Report / 대한고관절학회지

Percutaneous iliosacral screw fixation is commonly practiced to treat unstable posterior pelvic ring injuries. The number of reported cases of iatrogenic complications is increasing. We present a case of superior gluteal artery injury during bilateral percutaneous iliosacral screw fixation in a patient with sacral fracture of spino-pelvic dissociation. This complication was managed by arterial embolization. We discussed the cause, prevention and treatment of arterial injury along with a review of literature.

Study of Posterior Division of Internal Iliac Artery.

Background: The internal iliac artery originates from the common iliac artery at the level of sacroiliac joint. The internal iliac artery descends posterior to the greater sciatic foramen thereby dividing into anterior and posterior divisions. The posterior division of the internal iliac artery is known to give rise to three main branches i.e. iliolumbar artery, lateral sacral artery. Accidental haemorrhage is common during erroneous interpretation of anomalous blood vessels. The knowledge of the normal and the abnormal anatomy of the branches of the internal iliac artery is essential for obstetric surgeons. Methods: 50 adult human pelvic halves were procured from embalmed cadavers of J.J.M. Medical College and S.S.I.M.S & R.C, Davangere, Karnataka, India for the study. Results: Out of 50 specimens, ilio-lumbar artery took origin from posterior division, directly in 22 specimens (44%), with obturator artery in 5 specimens (10%) and with superior gluteal artery in 2 specimens (4%). From anterior division, with obturator artery in 6 specimens (12%) and with inferior gluteal artery in 1 specimen (2%). From common trunk, as direct branch in 10 specimens (20%), with lateral sacral artery in 1 specimen (2%), with vertebral branch in 1 specimen (2%), with superior gluteal artery in 1 specimen (2%) and was found to be absent in 1 specimen (2%). Posterior division of internal iliac artery given origin directly to superior gluteal artery in 44 specimens (88%), with ilio-lumbar artery in 1 specimen (2%), with obturator artery in 2 specimens (4%). Lateral sacral artery from posterior division was observed in 38 specimens (76%) and unpaired origin was observed in 7 specimens (14%). Conclusion: Internal iliac artery supplies the pelvic viscera and musculature the knowledge of its branches helpful in pelvis surgeries.

Application of Perforator Flap for the Oral and Maxillofacial Reconstruction

Superior Gluteal Artery-pedicled Iliac Crest for the Treatment of Avascular Necrosis of Femoral Head

INTRODUCTION: To evaluate the efficacy of superior gluteal artery-pedicled iliac crest for the treatment of avascular necrosis of femoral head. MATERIAL & METHOD: From January 2001 to October 2001, we used the superior deep branches of superior gluteal artery for the pedicled posterior iliac crest bone graft to revascularize the avascular femoral head in 4 patients. They were 1 man and 3 women, and the mean age of the patients was 34 years (range, 27 to 60). The average follow-up after surgery was over 57 months (range, 15 to 82). We analyzed the clinical results by the Harris hip score, and evaluated the vascularity of the femoral head by radiographic methods. RESULTS: All cases showed no evidence of collapse on femoral heads and good revascularizations on the radiographic images. The average Harris hip score was 88.5 points. There was no complication. CONCLUSION: The revascularization procedure using the superior gluteal artery-pedicled posterior iliac crest was thought to be one of the effective and promising techniques for the treatment of the avascular necrosis of femoral head.

Absence of Inferior Gluteal Artery: A Rare Observation / Ausencia de la Arteria Glútea Inferior: Una Rara Observación

The gluteal region is an important anatomical and clinical area which contains muscles and vital neurovascular bundles. They are important for their clinical and morphological reasons. In this manuscript we report a rare case of absence of inferior gluteal artery. In the same specimen the superior gluteal artery was taking origin from the anterior division of internal iliac artery. The structures normally supplied by the inferior gluteal artery were supplied by a branch coming from the superior gluteal artery. The developmental and clinical significance of the anatomical variation is discussed.

La región glútea es una importante área anatómica y clínica, la cual contiene músculos y vitales elementos neurovasculares. Estos últimos son importantes por razones clínicas y morfológicas. En este trabajo describimos un raro caso de ausencia de la arteria glútea inferior. Encontramos también que la arteria glútea superior tenía su origen en la división anterior de la arteria iliaca interna. Las estructuras irrigadas normalmente por la arteria glútea inferior estaban irrigadas por una rama que se originaba de la arteria glútea superior. Son discutidos el desarrollo y el significado clínico de esta variación anatómica.

Superior Gluteal Artery Pseudoaneurysm without Pelvic Bone Fracture: A Case Report

Pseudoaneurysm is defined as the aneurysmal cyst resulted from partial or total rupture of vessel membrane, and it can be caused by fracture, operation, laceration, blunt trauma, osteochondroma and so on. When the displaced pelvic bone fracture is diagnosed, the traumatic pseudoaneurysm, which is frequently related by the direct injury of vessel, is one of the common complications, and it can result the massive hemorrhage even death. In case of the displaced pelvic bone fracture, surgeon should check the hemoglobin level and vital sign carefully for the possibility of vascular injury. Authors report the rare case of superior gluteal artery pseudoaneurysm without pelvic bone fractrure.

An Anatomical Study of the Superior and Inferior Gluteal Arteries Supplying Gluteus Maximus for Musculocutaneous Flaps / 체질인류학회지

The tissues of gluteal region including skin and underlying gluteus maximus muscle are used for reconstructions of head and neck deformities caused by trauma and lumbosacral defects caused by bed sores, and for reconstruction of breast. Moreover, gluteus maximus flaps were used for reconstruction of anal -and vaginal -sphincter dysfunctions after radical resection for treatment of cancer in anorectal or vaginal region. Because the knowledge on the precise course and branching patterns of the arteries supplying the gluteus maximus muscle enables the prediction of the safety of surgery, the perforating branches supplying skin and subcutaneous tissues which exited from the gluteus maximus muscle, the positions of the superior and inferior gluteal arteries exited from pelvic cavity under the gluteus maximus muscle, and the course of these arteries under surface of the muscle were investigated. Total ninety -one dissected gluteus maximus from 47 Korean cadavers (44 bilateral specimens and 3 unilateral specimens) were observed. The perforating branches exited from the gluteus maximus were divided into upper and lower parts. The superior gluteal artery supplied upper two fifth of gluteal region and the inferior gluteal artery supplied the rest of gluteal region. The positions of superior and inferior gluteal arteries exited from pelvic cavity were in 1 cm medial to upper one third point on connecting line from posterior superior iliac spine to greater trochanter of femur, and middle point on connecting line from posterior superior iliac spine to ischial spine, respectively. The courses of the superior and the inferior gluteal arteries were classified into four types by distribution patterns. The most common incidence (46.5%) was observed in the typical type (Type I) that the superior and inferior gluteal artery supplied the upper or lower part of gluteus maximus muscle, respectively. The incidence of type II that some branches of inferior gluteal artery run up to the area supplied by superior gluteal artery was 16.3%. In contrast to type II, the incidence of type III that some branches of superior gluteal artery run down to the area supplied by inferior gluteal artery was 18.6%. The incidence of Type IV that only superior gluteal artery supplied the muscle was 18.6%.

A Case of Hypovolemic Shock Associated with Superior Gluteal Artery Rupture Without Pelvic Fracture in Blunt Trauma

Superior gluteal artery rupture without pelvic fracture is extremely rare, but the rupture of this vessel is a well-known complication of pelvic fractures. This vessel appears to be at risk at the time of pelvic fracture because of its vulnerable anatomical position in the sacrosciatic notch. The rupture of this vessel causes profound hypotension and compartment syndrome of the gluteal or thigh region. Embolization is the most effective treatment. We report an unusual case of a superior gluteal artery rupture without pelvic fracture in blunt trauma.

Free Flap Coverage for Radiation Ulcer on Lumbosacral Region

Since radiation was considered as a major therapeutic modalities, chronic ulceration on lumbosacral area has been eventually generated. When the lumbosacral soft tissue defect cannot be closed with a local flap, the option of a free flap should be considered. Vascularized muscle flap is a good choice on the radiation ulcer due to chronic infection and the tissue changes of radiation effects. From October 1998 to March 2001, six patients of radiation ulcer was received microvascular transfer of five free latissimus dorsi muscle flaps and one latissimus dorsi myocutaneous flap using the superior gluteal vessel as a recipient. Patients' age ranged from 45 to 74 (mean 63.3 years of age). Mean follow-up period was 19.7months (1 to 43 months). All the flaps survived with complete recovery. One case of skin graft loss was completely healed without any further intervention. In conclusion, free muscle flap with hyperbaric oxygen therapy could be successfully applied for the treatment of radiation ulcer on lumbosacral area. It can be concluded that free muscle flap transfer with hyperbaric oxygen therapy can be a preferable therapeutic modality for radiation ulcer in lumbosacral area.