Classification of Flaps
The most comprehensive classification of flaps is based on the six C’s proposed by Cormack and Lamberty.
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Classification of Flaps
The most comprehensive classification of flaps is based on the six C’s proposed by Cormack and Lamberty. Circulation • Axial • Septocutaneous • Myocutaneous Constituents • Fasciocutaneous • Musculocutaneous • Cartilage • Bone • Nerve • Visceral Contiguity • Local • Regional • Free Construction • Uni-/bipedicled • Orthograde flow Conditioning • Delay • Tissue expansion • Prefabrication Conformation • Special shapes • Tubed • Combined flaps B.M. Erovic, P. Lercher, Manual of Head and Neck Reconstruction Using Regional and Free Flaps, DOI 10.1007/978-3-7091-1172-7_3, © Springer-Verlag Wien 2015
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3 Classification of Flaps
Fasciocutaneous, muscle, and osseous flaps have been further classified as follows: 1. Fasciocutaneous Flaps (a) Cormack and Lamberty presented their classification of fasciocutaneous flaps based on the number of vessels and type of vascularization (Fig. 3.1a,b,c). 3.1a
3.1b
3.1c
a: Multiple perforators b: Single perforator c: Segmental perforator (b) Mathes and Nahai’s classification is based on three types of deep fascial perforators. (c) Nakajima’s classification is based on the course of small vessels from their origin to the skin. Type III fasciocutaneous flaps, supplied by “a perforating cutaneous branch of a muscular vessel” (III), have become the backbone of an entirely new genre of muscle perforator flaps. 2 . Classification of Muscle Flaps by Mathes and Nahai Muscle flaps are categorized according to the pattern of the predominant vessel (Fig. 3.2a,b,c,d,e).
Classification of Flaps
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Type I: A single vascular pedicle enters the muscle, i.e., the tensor fascia lata muscle (a). Type II: One dominant vascular pedicle with additional smaller vascular branches supplies the temporal muscle (b). Type III: Two vascular pedicles arising from separate regional arteries supply the muscle, i.e., the rectus abdominis muscle (c). Type IV: Several small vascular pedicles of similar size supply the muscle, including the vastus medialis muscle (d). Type V: One dominant vascular pedicle and several smaller secondary segmental vascular pedicles supply the muscle, including the pectoralis major muscle (e). 3.2a
3.2d
3.2b
3.2e
3.2c
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3 Classification of Flaps
3. Osseous flaps, according to Serafin, are either directly (a. endosteal) or indirectly (b. periosteal) vascularized (osseous flaps) (Fig. 3.3a,b). 3.3a
3.3b
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