Superior gluteal artery perforator flap in reconstruction of sacral defects: A modified approach with minimal pedicle dissection

Background: Providing durable coverage to large sacral defects represents a significant reconstructive challenge in plastic surgery. Myocutaneous flaps have traditionally been the reconstruction technique for Stage 4 sacral defect coverage, yet they sacrifice functional muscle integrity and limit future reconstructive options. The superior gluteal artery perforator (SGAP) flap offers excellent vascularization and abundant tissue for even large defect coverage while preserving gluteal muscle function. Aims and Objectives: This study presents a modified approach to SGAP flap harvest emphasizing minimal pedicle dissection to simplify the procedure and reduce operative morbidity. Materials and Methods: A retrospective analysis of 22 consecutive patients who underwent SGAP flap reconstruction for sacral defects between January 2022 and September 2025 was done. We employed a modified technique of SGAP flap elevation emphasizing minimal pedicle dissection to reduce operative time and vessel trauma. Patient demographics, defect characteristics, flap specifications, operative time, post-operative outcomes, and complications were systematically documented. Results: Twenty-one of 22 flaps (95%) demonstrated complete survival with excellent functional outcomes. One flap developed marginal necrosis, partial wound edge dehiscence in one patient, distal venous congestion in one patient. No donor site morbidity, flap-related mortality, or recurrence of sacral defect was observed during follow-up. Conclusion: The modified SGAP flap technique with strategic perforator selection and minimal pedicle dissection represents a viable and efficient alternative for sacral defect coverage. Key advantages include significantly reduced operative time, decreased intraoperative blood loss, minimal vessel trauma, and preserved gluteal muscle function without compromising flap reliability.