COMPARISON OF DETECTION OF SUPERIOR GLUTEAL ARTERY PERFORATOR BY INDOCYANINE GREEN

FLUORESCENCE NEAR-INFRARED ANGIOGRAPHY AND ACOUSTIC DOPPLER SONOGRAPHY FOR RECONSTRUCTION OF SACRAL PRESSURE INJURY

Chien-Wei Wu and Yuan-Sheng Tzeng

Division of Plastic and Reconstruction Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

Introduction

Pressure injuries are areas with tissue necrosis and ulceration where soft tissues are compressed between hard surfaces and bony structure. Once deep tissue infection is noted, in-hospital care, along with surgical interventions, is beneficial for patients. Several different kinds of flaps have been introduced over the years for reconstructing sacral defects, such as local flaps, V-Y advancement fasciocutaneous flaps, gluteus maximum muscle-based flaps, inferior gluteal artery perforator flaps, and superior gluteal artery perforator (SGAP) flaps.Reliable perforators are the most important factors for successful perforator based flaps reconstruction

A hypothetical line was drawn between the posterior superior iliac spine (PSIS) and the lateral border of the great trochanter on the side of the buttock from which the SGAP flap was planned to be harvested. B) A hypothetical line was drawn between the posterior superior iliac spine (PSIS) and the lateral border of the great trochanter on the side of the buttock from which the SGAP flap was be harvested.

The superior gluteal artery (SGA) and its perforators were identified with ICGFA and ADS.

Material and method

Accurate preoperative mapping of the perforators is essential for the safe planning of propeller flaps. Various methods have been reported to date: handheld acoustic Doppler sonography (ADS), indocyanine green fluorescence near-infrared angiography (ICGFA)

We retrospectively reviewed data from 16 patients with sacral pressure injury who underwent modified SGAP flap reconstruction surgery.
All patients age 65 years and over with sacral pressure injury stage III to stage IV, and massive soft tissue defect coverage with an SGAP flap between January 2019 and January 2021, who met the inclusion criteria were

included in this study.

Results

SGAP flap was tunnelled beneath a skin strip between the defect and the flap donor site.

Conclusion

The combination of the detection of SGAP by ICGFA and by handheld ADS for the reconstruction of sacral pressure injury provides a more accurate method and provides the advantage of being radiation-free.

Reference

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