Trials and tribulations with the inferior gluteal artery perforator flap in autologous breast reconstruction

Background: Perforator free flaps from the buttock serve as an alternative to abdominally based flaps in autologous breast reconstruction. Microsurgeons often opt to harvest tissue from the gluteal donor site because of a lack of abdominal volume and/or quality. The authors examined the experience of a single surgeon with the inferior gluteal artery perforator (IGAP) flap and provide a quantitative outcomes comparison with the deep inferior epigastric perforator (DIEP) flap. Methods: A retrospective review was performed of patients who underwent IGAP flap surgery for autologous breast reconstruction from August of 2005 to October of 2010 performed by a single surgeon (J.M.S.). Results: Thirty-one inferior gluteal artery perforator flaps were performed on 24 patients. Mean follow-up time was 24.4 months (range, 6 to 65 months). The total flap loss rate was 6.5 percent, and the take-back rate was 13 percent (salvage rate, 75 percent). Vascular complication rates were as follows: intraoperative arterial thrombosis, 13 percent; intraoperative venous thrombosis, 3 percent; delayed arterial thrombosis, 3 percent; and delayed venous thrombosis, 13 percent. Nineteen percent of patients had sensory complaints at the donor site that persisted beyond 3 months postoperatively. In comparison to the DIEP flap, IGAP flaps had a higher rate of intraoperative arterial thrombosis (13 percent versus 2.6 percent, p = 0.024) and delayed venous thrombosis (13 percent versus 1.5 percent, p = 0.008). Conclusions: Review of the IGAP flap reveals some shortcomings of this flap even in the hands of an experienced microsurgeon. Surgeons should be aware of the difficulties and limitations when choosing this flap for reconstruction.