[The inferior gluteal musculocutaneous flap: Short and long-term results for 69 patients]

The inferior gluteal musculocutaneous flap described by Shaw then Le-Quang offers the possibility of harvesting a large amount of tissue with a well-concealed scar in the inferior fold. Since 1996, we used this flap for breast reconstruction without implant. The purpose of this study was to assess short and for long-term results in our patients. Between 1996 and 2005, 64 patients underwent 69 musculocutaneous flaps by two seniors surgeons, for secondary unilateral reconstruction (57 cases, 51 total mastectomy, three partial mastectomy, three constitutional breast asymmetry), five bilateral reconstruction or one thoracic skin ulceration after radiotherapy. The average flap weight and size was respectively 360g and 18 × 7cm. For short results, the assessment was based on flap success and surgical morbidity. For long-term results, the assessment was based on breast result (shape, volume, symmetry, skin and scar) and donor-site morbidity (scar, contour deformity, muscle function and sensation). Patients and surgeons global satisfaction were compared. Minimal follow-up was three years for 60 patients. Two patients died with metastasis. Sixty-three flaps succeeded. We had five flap necrosis, one after general complication (pulmonary embolism), four after venous thrombosis during the first period of our experience. Forty patients underwent a second procedure on the flap or on the other breast (25 cases). For the patients, the global result was excellent in 20 cases, good in 32 cases, fair in nine cases. For surgeons the global result was excellent in 13 cases, good in 32 cases, fair in 13 cases and poor in three cases. Concerning the donor-site, only one patient had an asymmetry of the buttock. Mostly, the scar of the donor site was good. Five cases needed a new surgery for poor scar. Five patients had functional complaints (for bicycle and squatting). Twenty-three patients noticed the hypoesthesia in the territory of the posterior femoral cutaneous nerve. For breast reconstruction, the gluteal region is an acceptable donor site with low morbidity and stable results. This technique needed a relative long learning curve, especially for the venous pedicle. We recommend to use a large vein dissected from the arm and axillary vessels. We also reduce the harvesting volume of the muscle to preserve the function. The reconstructive breast had a good shape, sufficient volume and acceptable symmetry.