The Superior Gluteal Artery Perforator (SGAP) flap has been described as both a free flap, in particular for breast reconstruction and as a pedicled flap for lumbar and sacral soft tissue reconstruction. Much of the evolution of the flap was through work on sacral pressure sores. Kroll and Rosenfield1 described the use of perforator based flaps to reconstruct low posterior midline defects in the late 1980s. This work was further evolved by Koshima, whose work on pressure sores led him to explore the anatomy of the gluteal artery perforators. Verpaele modified this further by selecting the superior gluteal artery perforator as the flap of choice for reconstruction in the sacral area. Leow et al demonstrate the successful use of the flap in the management of sacral pressure sores in cases of acquired paralysis. The SGAP flap has not been described in the literature in patients who have been non-ambulatory since birth.
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