Type A
A pedicled flap based on several vessels entering the base of the flap and following the long axis of the flap
Type B
A pedicled or a free flap based on a single perforator vessel at the level of the deep fascia
Type C
A pedicled or a free flap based on multiple small perforators originating from a deep artery and reaching the fascia along a septum between muscles
Type D
Fasciocutaneous flap that is harvested in with the adjacent muscle and/or bone with the same feeding artery
Musculocutaneous flaps are based on perforator vessels that reach the skin through muscular tissue. According Mathes and Nahai classification, those can be divided in five types according the number on pedicles and their vascular dominance (Figs. 2.2, 2.3, 2.4, 2.5, and 2.6).
Type 1 | A single feeding vessel entering the muscle. For example, the tensor fascia lata |
Type 2 | A single dominant feeding vessel with smaller minor ones entering the muscle. For example, the gracilis |
Type 3 | Several dominant feeding vessels arising from different arteries. For example, the gluteus maximus |
Type 4 | Multiple segmental feeding vessels. For example, the sartorius |
Type 5 | One dominant feeding vessel and secondary segmental vascular pedicles. For example, the latissimus dorsi |
The Cormack and Lamberty classification of fasciocutaneous flaps
Type 1. The tensor of fascia lata muscle takes origin from the anterior iliac crest and inserts into the iliotibial tract and is supplied by the ascending branch of the lateral circumflex femoral artery
Type 2. The gracilis muscle is a long muscle that is supplied by the adductor branch of the profound femoral vessels or the medial circumflex femoral vessels. In addition, two secondary pedicles can be found distally
Type 3. The gluteus maximus is supplied by the superior gluteal artery and by the inferior gluteal artery
Type 4. The latissimus dorsi muscle is supplied by two separate vascular systems. The main blood supply arises from the thoracodorsal artery via the subscapular artery. There is a secondary blood supply that arises from segmental perforating branches off of the intercostal and lumbar arteries
Type 5. The sartorius muscle is supplied by multiple segmental pedicles. For each third of muscle, there is at least one vascular pedicle, often two pedicles, and occasionally three each arising from the superficial circumflex iliac artery, from the saphenous artery, or from the descending genicular artery
2.2 Composition
Flaps can also be classified according to the composing tissue: cutaneous, fasciocutaneous, fascial, musculocutaneous, muscle, osseocutaneous, and osseous.
2.3 Contiguity
Local flaps: the tissue used for repairing lies adjacent to defect.
Regional flaps: the flap is elevated from the same region of the body of the defect.
Distant flaps: the tissue comes from a distant region of the body. These flaps can be pedicled or free depending on the detachment on the vascular pedicle. Free flaps are basically autotransplants, where the tissue is transferred using microsurgery to reestablish circulation making an anastomosis.
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