Local Flap : When the skin flap is from an area close to the wound, for example, a wound on the lip may be repaired by a flap from the adjacent cheek. Regional Flap : When the skin flap is not from the adjacent area, but is from the same region of the body, for example, a wound on the tip of nose might be repaired with a flap from the forehead. Distant Flap: When a flap is from a different part of the body, for example, a wound on the hand might be repaired with a flap raised in the groin. A local flap repair is usually done in one operation, whereas regional and distant flaps need two or more operations. The second operation is needed to detach one end of the flap at the donor site, when the blood vessels have developed at the other end. Free Flap: This is a distant flap, but the whole procedure is done in one stage by repairing the donor and blood vessels by microsurgery.
Methods of classification• Composition – Skin +/- fascia – Muscle (+/- innervation) – Bone – Omentum / viscera – Composite• Proximity to defect• Method of movement• Vascular anatomy
Proximity to defect• Local• Regional• Distant• Free
Arterial supply of the skin
Method of movement• Advancement• Transposition• Rotation• Interpolation• Waltzing
Type A Type B Type CDirect cutaneous Fasciocutaneous Musculocutaneouspedicle pedicle pedicleDeep external pudendal ALT ALTDigital artery Anterior + posterior tibial DeptopectoralDorsal metacarpal Deltoid NasolabialGluteal Dorsalis pedis Median foreheadGroin Inferior cubital (antecubital) ThoracoepigastricLateral thoracic Lateral + medial arm (transverse abdominal)Pudendal Lateral + medial plantar Transverse backSaphenous Lateral + medial thighScalp PeronealForehead Posterior interosseousSuperficial external Radial + recurrentpudendal ScapularSuperficial inferior epigastric UlnarSuralTemporoparietal fascia
I One II Dominant III Two IV V Dominantvascular vascular dominant Segmental vascularpedicle pedicle + pedicles supply pedicle + minor secondary pedicle segmental pediclesColon Gracilis Omentum EDL, EHL, FibulaJejunum Hamstrings Gluteus FDL, FHL Lat dorsi maximus Tibialis antDCIA Soleus Pec major Pec minor SartoriusGastrocs SCM Rectus ExternalTFL TrapeziusVastus Serratus oblique anteriorlateralis Temporalis