• 대한정형외과 초음파학회지
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• 제5권1호
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• pp.27-30
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• 2012

피하 조직에 발생하는 연부조직 종괴에는 다양한 병변이 있으며, 연부조직의 낭성 종괴중에서 혈종은 보통 외상과 관련되거나 혈액응고 장애가 있는 경우에 발생하는 경우가 많다. 저자들은 특별한 원인 없이 2개월 전 우연히 발견되고 크기가 서서히 증가하는 좌측 둔부의 종괴를 주소로 내원한 70세 여자환자에서 초음파를 이용하여 혈종으로 진단하고 제거수술을 시행한 증례를 보고하고자 한다.

• Archives of Reconstructive Microsurgery
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• 제26권1호
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• pp.14-17
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• 2017

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.

• Archives of Plastic Surgery
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• 제35권6호
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• pp.692-697
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• 2008

Purpose: Gluteal perforator flap has evolved to one of the standard tools for coverage of pressure sore. We used this flap to cover the defect adjacent to the buttock. Methods: From September 2004 to August 2006, gluteal perforator flaps were performed in 3 patients with sore and 9 patients with tumor. We made the rule for free style design of the flap. First, the defect should be covered fully regardless of the shape or area. Second, the location of perforators was decided to maximize flap mobility. Third, the donor-site should be closed directly. Results: Successful reconstruction was fulfilled. In 2 cases, initial flap congestion was observed but medical leech was applied and it was resolved. Partial flap loss occurred in one case. Infection was observed in one case. But there were no major complications. Conclusion: Gluteal perforator flap is very good option for the reconstruction of the defects adjacent to the buttock.

• Archives of Reconstructive Microsurgery
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• 제25권2호
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• pp.49-55
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• 2016

Purpose: Soft tissue defects in the lumbosacral area can be challenging to treat, and various methods to accomplish this have been proposed, including the use of perforator flaps. Herein, we present our experience with superior gluteal artery perforator (SGAP) and inferior gluteal artery perforator (IGAP) flaps for the reconstruction of lumbosacral defects. Materials and Methods: From March 2013 to July 2016, 28 cases (27 patients) of lumbosacral defects were treated by reconstruction with SGAP or IGAP flaps. The defects were caused by pressure sores (21 cases), burns (3 cases), tumor resection (2 cases), scars (1 case), or foreign body infection (1 case). Reliable perforators around the defect were found using Doppler ultrasound. The perforator flaps were elevated with a pulsatile perforator and rotated to cover the defects. Results: Twenty-three SGAP and 5 IGAP flap reconstructions were performed. The mean flap size was $9.2{\times}6.1cm^2$ (range, $5{\times}3cm^2$ to $16{\times}10cm^2$). Donor sites were closed by primary closure. Partial flap necrosis occurred in two cases, and minor complications of wound dehiscence occurred in 3 cases, which were healed by primary closure. The mean follow-up period was 4.4 months (range, 1~24 months). Conclusion: Gluteal-based perforator flaps can be safely harvested due to pliability and reliable vascularity in the gluteal area, reducing donor site morbidity without sacrificing the underlying muscles. Thus, these flaps are useful options for the reconstruction of lumbosacral defects.

• Archives of Plastic Surgery
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• 제41권2호
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• pp.133-139
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• 2014

Background Various shapes and designs of the gluteal artery perforator flap have been used for treating sacral pressure sores and reconstructing breasts. To establish the ideal fasciocutaneous flap design for use in the gluteal area, the soft tissue thickness distribution was measured. Methods Twenty-one buttocks of adult Korean cadavers were analyzed through rectangular subfascial dissection. Each buttock was divided horizontally into 10 sections and vertically into 10 sections, and then, the thickness at the corners of the sections was measured. For the sake of comparison and statistical verification with living bodies, computed tomography (CT) images of 120 buttocks of patients were randomly selected. Five horizontal sections and 4 vertical sections were made, and the thickness at each corner was recorded. Results According to the dissection and the CT images, the area with the thinnest soft tissues in the buttock was around the posterior superior iliac spine, close to the sacral area. The thickest area was the superolateral area of the buttock, which was 3.24 times and 2.15 times thicker than the thinnest area in the studies on cadaver anatomy and the CT images, respectively. Conclusions The thickness of the soft tissues in the buttocks differed by area. The superolateral area had the thickest soft tissues, and the superomedial area had the thinnest. This study includes information on the distribution of the thickness of the gluteal soft tissues of Koreans. The outcome of this study may contribute to the design of effective local flaps for pressure sore reconstruction and free flaps for breast reconstruction.

• Archives of Reconstructive Microsurgery
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• 제25권1호
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• pp.15-18
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• 2016

Any types of burn injury that involve more than deep dermis often require reconstructive treatment. In gluteal region, V-Y fasciocutaneous advancement flap is frequently used to cover the defect. However, in case of large burn wounds, this kind of flap cannot provide adequate coverage because of the lack of normal surrounding tissues. We suggest V-Y adipofascial flap using the surrounding superficially damaged tissue. We present the case of a patient who was referred for full-thickness burn on gluteal region. We performed serial debridement and applied vacuum-assisted closure device to defective area as wound preparation for coverage. When healthy granulation tissue grew adequately, we covered the defect with surrounding V-Y adipofascial flap and the raw surface of the flap was then covered with split-thickness skin graft. We think the use of subcutaneous fat as an adipofascial flap to cover the deeper defect adjacent to the flap is an excellent alternative especially in huge defect with uneven depth varying from subcutaneous fat to bone exposure in terms of minimal donor site morbidity and reliability of the flap. Even if the flap was not intact, it was reuse of the adjacent tissue of the injured area, so it is relatively safe and applicable.

• Archives of Plastic Surgery
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• 제37권5호
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• pp.712-716
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• 2010

Purpose: Extensive lumbosacral defects after removal of spinal tumors have a high risk of wound healing problems. Therefore it is an effective reconstructive strategy to provide preemptive soft tissue coverage at the time of initial spinal surgery, especially when there is an instrument exposure. For soft tissue reconstruction of a lumbosacral defect, a variation of the gluteal flap is the first-line choice. However, the musculocutaneous flap or muscle flap that is conventionally used, has many disadvantages. It damages gluteus muscle and causes functional disturbance in ambulation, has a short pedicle which limits areas of coverage, and can damage perforators, limiting further surgery that is usually necessary in spinal tumor patients. In this article, we present the superior gluteal artery perforator turn-over flap that reconstructs complex lumbosacral defects successfully, especially one that has instrument exposure, without damaging the ambulatory function of the patient. Methods: A 67 year old man presented with sacral sarcoma. Sacralectomy with L5 corpectomy was performed and resulted in a $15{\times}8\;cm$ sized complex soft tissue defect in the lumbosacral area. There was no defect in the skin. Sacral stabilization with alloplastic fibular bone graft and reconstruction plate was done and the instruments were exposed through the wound. A $18{\times}8\;cm$ sized superior gluteal artery perforator flap was designed based on the superior gluteal artery perforator and deepithelized. It was turned over 180 degrees into the lumbosacral dead space. Soft tissue from both sides of the wound was approximated over the flap and this provided in double padding over the instrument. Results: No complications such as hematoma, flap necrosis, or infection occurred. Until three months after the resection, functional disturbances in walking were not observed. The postoperative magnetic resonance imaging scan shows the flap volume was well maintained over the instrument. Conclusion: This superior gluteal artery perforator turn-over flap, a modification of the conventional superior gluteal artery perforator flap, is a simple method that enabled the successful reconstruction of a lumbosacral defect with instrument exposure without affecting ambulatory function.

• Archives of Plastic Surgery
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• 제38권3호
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• pp.235-240
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• 2011

Purpose: Management of pressure sores has been improved, along with development of musculocutaneous flaps and perforator flaps. Nowadays, the treatment of pressure sore with perforator flaps has shown several advantages, including minimal donor site morbidity, relatively versatile flap design not only in primary cases but also in recurred cases and minimized anatomical rearrangement of regional muscle position. In this study, we report our clinical experience of gluteal perforator flap used in the treatment of a greater trochanteric pressure sore. Methods: A clinical study was performed on 7 patients who underwent total 10 operations. 1 superior gluteal artery perforator flap and 9 inferior gluteal artery perforator flaps were used to reconstruct the defect, followed by the mean observation duration of 22 months. Results: There were no total flap loss. We treated 2 cases of partial flap loss with debridement and primary repair. 2 recurred cases were successfully treated using the same method. Donor sites were all primarily repaired. Conclusion: The gluteal perforator flap could be considered as a safe and favorable alternative in the treatment of soft tissue defects in the greater trochanteric area. The advantages of the flap include low donor site morbidity and the possibility of versatile flap design not only in primary cases but also in recurred cases.

• Archives of Plastic Surgery
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• 제49권3호
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• pp.289-295
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• 2022

Background Massive weight loss (MWL) is a very common presentation that you may face as a plastic surgeon. Each patient has his own individual criteria, so, you should work according to a well-organized plan, especially when such cases have concerns about their gluteal area contour that were neglected before by many surgeons. A decision-making strategy was used to give a personalized treatment for targeting gluteal region reshaping of MWL patients. Methods This study considered all patients with MWL subjected to buttock reshaping. There was no randomization in treatment; there was a case-by-case assessment. We analyzed the features of the buttocks, the type of surgery performed, the outcomes, and the complications. Results Fifty two patients were included (41 females and 11 males), ages ranged between 21 and 66 years. Demographic data, preoperative body mass index (BMI), duration of surgery, type of surgery, and postoperative complications were collected. Statistically significant improvements were observed in gluteal ptosis and patient satisfaction grades. Conclusion Aesthetic improvement of the buttocks involves either augmentation or contouring that may be obtained by liposculpture, surgical lifting, or combination. Patients with MWL have high expectations and are often treated with multiple procedures. Thus, an easy strategic approach personalized on each patient to treat multiple adjacent areas in one operation is necessary. Adipose tissue distribution, gluteal skin status, and BMI were the main factors that can forcefully affect our plan to guarantee reduction of unpleasant results and complications and improve patient satisfaction.

• 한국의류학회지
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• 제25권8호
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• pp.1420-1431
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• 2001

This research was done to classify lower body types by direct measurements, side and back view types from waistline to gluteal furrow line individually, and to analyze correspondence these lower body types with side and back view types from waistline to gluteal furrow line. The subjects of this study were 191 female college students from 18 to 25 years old residing in Pusan urban area. Type 1(long and slim) of lower body types by direct measurements was correspond with Type 1(slim curve) and Type 4(slim and protrusive hip) of side view and Type 3(wide and curve) and Type 4(trapezoid shape) of back view. Type 2(short and thick) of lower body types was correspond with Type 3(thick and droopy hip) of side view and Type 1(wide and straight) of back view. Type 3(short and slim) of lower body types was correspond with Type 2(slim and flat hip) of side view and Type 2(narrow and curve) of back view.