Comparison of Superior Gluteal Artery Musculocutaneous and Superior Gluteal Artery Perforator Flaps for Microvascular Breast Reconstruction

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At the authors’ institution, the superior gluteal artery musculocutaneous flap has been replaced by the superior gluteal artery perforator flap for autologous breast reconstruction. The authors present a head-to-head comparison of the two techniques.


A retrospective chart review of 102 gluteal flap transfers in 80 patients compared the two methods with regard to perioperative details, complications (especially anastomotic), and the number of secondary procedures required to achieve optimal outcome. Statistical analysis was carried out, and a value of p < 0.05 was considered significant.


Seventy superior gluteal artery and 32 superior gluteal artery perforator flap procedures were performed over a period of 10 years. Patients in the superior gluteal artery perforator group tended to lose significantly less blood (375 cc versus 241 cc). There was no significant difference in the duration of surgery, hospital stay, or the overall complication rate. Even though the difference in the rate of anastomotic thrombosis (10 percent and 6 percent, respectively) was not statistically significant, patients in the superior gluteal artery group were prone to venous thrombosis, were more likely to require vein grafting, and had a higher rate of reoperation for anastomotic problems. There was no difference in the number of secondary operations.


This report provides some evidence of the superiority of the superior gluteal artery perforator flap over the superior gluteal artery flap for breast reconstruction, particularly with regard to ease and reliability of the microvascular anastomosis. However, in the expert hands of its early proponents, the superior gluteal artery flap did remarkably well.

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