Introduction: We present our experience with the SGAP ( superior gluteal artery perforator ) flap in the closure of sacral pressure sores. This fasciocutaneous perforator flap is a refinement of the myocutaneous flap concerning the donor site morbidity.

Methods: 28 cases with minimal complication's rate are presented. Over 90% of our patients with sacral sores were paraplegic. The mean age of the patients was 62 years ( range from 34 to 85 years), the average defect size was 8x 11 cm. The supplying artery from the SGAP can be located by Doppler making design of the flap simple. There are 6-8 perforators between the A.gluteous superior and the A. gluteous inferior. The largest perforators can be revealed in the parasacral and medial area. To increase arc of rotation the SGAP flap should be located around the lateral perforator. The operative procedure and the advantages of this flap are showed.

Results: In the last 24 month we have operated 28 patients using this flap. The main complication was seroma. In two cases a second operation was performed because of wound healing problems caused by hematoma and/or seroma. All other flaps healed without serious complications. A postoperative follow-up fotodocumentation demonstrated excellent aesthetic and functional results. Donor-site morbidity was well received from the patients.

Discussion: The most popular method for closing sacral scores is the gluteous maximus myocutaneous flap. The SGAP flap is a pedicled fasciocutaneous flap flap developed by Kroll and Rosenfield, Koshima et al. , and Verpaele et al. This operative procedure is in 28 patients applied and different surgical variations including turnover flaps, rotation flaps, island flaps and the sliding flap are presented . The advantage of the perforator flap is the minimal donor site morbidity and an intact muscle function ( especially in non-paraplegic patients. Our clinical experience is showed that the fasciocutaneous flaps presented better long lasting results than the myocutaneous or muscle flaps.