Superior and inferior gluteal artery perforators: In-vivo anatomical study and planning for breast reconstruction

Summary Background Gluteal artery perforator (GAP) flaps have gained popularity in autologous breast reconstruction, however substantial variability in vascular anatomy has limited their more widespread utilisation. While previous anatomical studies have been limited by specimen numbers and study design, computed tomographic angiography (CTA) can demonstrate in-vivo vascular anatomy in large numbers. We thus undertook an anatomical study with the use of CTA, the largest such study in the literature, and present a clinical series utilising CTA to plan GAP flaps. Methods Eighty consecutive patients (160 gluteal regions) underwent pre-operative CTA, with superior and inferior gluteal artery perforators (SGAPs and IGAPs) assessed for location, size and course. The utility of pre-operative CTA is explored in a series of seven consecutive patients undergoing autologous breast reconstruction. Results There were an average of 11 SGAPs per region (range 6–17), with mean diameter 0.6 mm (range 0.3–2.4) and SGAPs >0.8 mm diameter identified in every region. In contrast, there were nine IGAPs per region (range 5–14), with mean diameter 0.4 mm (range 0.3–1.6) and IGAPs >0.8 mm diameter identified in 95% of regions. Individual SGAP and IGAP territories were different between sides and between individuals, with the central tissue variably supplied by either system. In a clinical series, CTA was found to aid operative planning and correlate with operative findings. Conclusion There are regularly abundant SGAPs and IGAPs identifiable per gluteal region, and while many are diminutive in size, the identification of suitable perforators with CTA may aid operative planning for gluteal flap harvest.