A Novel Technique for Augmenting Venous Outflow in the Superior Gluteal Artery Perforator (SGAP) Flap

Katherine H. Carruthers, MD, MS; Ergun Kocak, MD, MS; Pankaj Tiwari, MD; Shunsuke Yoshida, MD


ePlasty. 2019;19(pb4) 

In This Article

Abstract and Introduction


In microvascular surgery, venous insufficiency is one of the most common complications leading to reoperation. To address this issue, techniques involving venous bypass or augmentation of venous outflow have been employed in a variety of free flap procedures. For example, the deep inferior epigastric artery perforator (DIEP) flap has a well-established method for augmenting the venous outflow by draining the superficial system.[1,2] This technique has been shown to be an effective and reliable method for improving venous congestion.[2]

In recent years, there has been a growing trend to utilize alternative autologous tissue for breast reconstruction. The superior gluteal artery perforator (SGAP) flap, in particular, has become a common choice when DIEP flaps are not an option.[3–5] The advantages of the SGAP flap are numerous, including the large volume of available tissue and the avoidance of an abdominal donor site, all while preserving the integrity of the gluteal muscle.[1,5,6]

While most surgeons agree that the SGAP flap is a technically demanding procedure due to anatomic variability during flap dissection and vessel mismatch at the anastomosis site, there are few reported techniques for SGAP flap salvage.[3,4,7] Even in the most experienced of hands, there is still a risk of flap compromise, and if reoperation does occur, it is most often due to venous complications.[2,8] Yet, to date, no prior studies have reported a reliable technique for augmenting venous flow in the SGAP flap. We herein report a method for augmenting venous outflow in the SGAP flap in the setting of autologous breast reconstruction.