What question did this study set out to answer?

To explore the use of the lumbar artery perforator transposition flap as a salvage strategy for a compromised superior gluteal artery perforator flap following tumor resection.

March 2, 2026Journal of Plastic and Reconstructive Surgery0 citationsOpen Access

Giant Lumbar Artery Perforator Transposition Flap as a Salvage Strategy for Failed Superior Gluteal Artery Perforator Flap in Near-Total Gluteal Defect following Sacral Malignant Peripheral Nerve Sheath Tumor Resection

GMGrace Mathai KMKunal Mokhale TDTushar Deka

Key Points

To explore the use of the lumbar artery perforator transposition flap as a salvage strategy for a compromised superior gluteal artery perforator flap following tumor resection.
Reported case of a 33-year-old female with NF-1 and recurrent MPNST.
Initial reconstruction attempted using SGAP and V-Y advancement flaps.
LAP transposition flap used for salvage after SGAP flap failure due to venous congestion.
Stable coverage achieved with the LAP transposition flap and skin graft for remaining defect.
LAP transposition flap provided stable coverage for the large defect.
Initial SGAP flap discarded intraoperatively due to complications.
Remaining small defect successfully managed with split-thickness skin graft.

Abstract

In patients with neurofibromatosis type 1 (NF-1), malignant peripheral nerve sheath tumors (MPNSTs) are highly aggressive sarcomas. We report a case of a 33-year-old female with NF-1 who had a recurrence of high-grade MPNST in the sacral region within 1 month of primary wide excision and split-thickness skin grafting. Secondary excision led to a large defect (25 × 20 cm) with an exposed sacrum. The defect was managed with a left-sided superior gluteal artery perforator (SGAP) flap and a right-sided V-Y advancement flap; however, the SGAP flap was discarded intraoperatively due to venous congestion. As a salvage measure, the defect was managed with a left fourth lumbar artery perforator (LAP) transposition flap. Stable coverage was achieved with the LAP transposition flap, while the remaining small defect was managed with a split-thickness skin graft. Thus, the LAP transposition flap is a viable alternative in patients with compromised SGAP flaps for near-total gluteal defect reconstruction of the sacral region.

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