The Thin Gluteal Artery Perforator Free Flap to Resurface the Posterior Aspect of the Leg and Foot

Background: The authors evaluated the clinical application of the gluteal artery perforator free flap harvested above the superficial fascia as a new approach to reconstruct soft-tissue defects of the posterior aspect of the lower limb. Methods: Between September of 2010 and August of 2013, 27 thin flaps were used to reconstruct lower extremity defects in 27 patients. All flaps were elevated on the superficial fascia plane and based on a single perforator from either the superior or inferior gluteal artery. Results: With the exception of two flaps that healed secondarily after partial loss, all flaps survived completely. Average flap thickness was 8.5 mm (range, 5 to 11 mm). The average flap size was 125 cm(2) (range, 9 x 4 cm to 25 x 12 cm). The average pedicle length was 5.5 cm (range, 3 to 8 cm.). The average artery diameter was 0.65 mm (range, 0.4 to 1.3 mm). During the average follow-up of 13 months (range, 2 to 35 months), all flaps showed good contour and did not require any secondary revisions. Conclusions: The gluteal artery perforator free flap provides a thin flap for ideal contour, minimizes the operative risks of changing the patient's position intraoperatively, and conceals the donor site with minimal morbidity. However, the pedicle can be short and supermicrosurgery skills may be needed to accommodate the short pedicle. Overall, this new approach of using a thin gluteal artery perforator free flap to reconstruct the posterior aspect of the leg and foot can be considered a feasible option.