KEY NOTES CHAPTER 1: GENERAL PRINCIPLES (C) Classification of flaps.

Question 0

How do you classify flaps by circulation?

Answer 0

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Axial

• direct (e.g. deltopectoral - IMA, groin - SCIA)
• fasciocutaneous,
• musculocutaneous,
• venous.

Question 1

How do you classify flaps?

Answer 1

Circulation.
Composition.
Contiguity.
Contour.
Conditioning.

Question 2

What is the Cormack and Lamberty classification of FC flaps?

Answer 2

Type A - multiple FC vessels entering from base of flap e.g. Ponten.
Type B - single axial FC vessel e.g. scapular / parascapular flap, perforator DC flaps of lower leg.
Type C - multiple small perforating vessels from deep artery running along a fascial septum between muscles e.g. radial forearm, lateral arm flaps.
(Type C with bone).

Question 3

What is the Mathes and Nahai classification of FC flaps?

Answer 3

Type A - direct cutaneous pedicle. e.g. groin, SIEA, dorsal metacarpal artery flaps.
Type B - septocutaneous. e.g. scapular, parascapular, lateral arm, PIA flaps.
Type C - musculocutaneous. e.g. median forehead, nasolabial, ALT (usually).

Question 4

How are muscle and musculocutaneous flaps classified?

Answer 4

Mathes and Nahai (1981 PRS).

1. single pedicle.
2. dominant and minor (unreliable) pedicles.
3. 2 dominant.
4. multiple segmental.
5. 1 dominant, secondary segmental pedicles (can raise on either).

Question 5

Give examples of each.

Answer 5

1. gastrocnemius, TFL, ADM.
2. trapezius, soleus, gracilis.
3. rectus abdominis, pectoralis minor, gluteus maximus.
4. sartorius, tibialis ant, long toe extensors and flexors.
5. latissimus dorsi, pec major.

Question 6

How are venous flaps classified?

Answer 6

Thatte and Thatte.

1. single venous pedicle.
2. venous flow through flaps.
3. arterialised venous flap (AVA proximally).
   e. g. saphenous flap (based on LSV), unpredictable, prone to congestion.

Question 7

How are flaps classified by composition?

Answer 7

Cutaneous.
Fasciocutaneous.
Fascial.
Musculocutaneous.
Muscle.
Osseocutaneous.
Osseous.

Question 8

How are flaps classified by contiguity?

Answer 8

Local - donor site adjacent to defect.
Regional - within the same region.
Distant.

Question 9

How are flaps classified by contour (how they are transferred into defect)?

Answer 9

1. Advancement.
2. Transposition.
3. Rotation (in reality, flaps are rotated and transposed, i.e. pivot flaps).
4. Interpolation (under or above intervening piece of tissue).
5. Crane principle - transforms an ungraftable bed to graftable.