Flaps by composition

Skin/Cutaneous flaps
• Axial (with named artery)
• Random (no named artery)

Fasciocutaneous flaps
• Deep fascia included in flap
• Easier to elevate and transfer
• Decreased bulk
• Reliable blood supply and decreased functional morbidity at the donor site

Myocutaneous flaps
• Combines muscle, skin, and intervening fascia and subcutaneous tissue
• Supplied by one or more dominant vascular pedicle
• Increased bulk and increased resistance to bacterial infection
• Muscle can be transferred alone without overlying fascia and cutaneous tissue

Bone flap
• Can be part of an osseocutaneous flap
• Dominant vascular pedicle with perforating branches supply the skin and
periosteum
• Can be harvested as a free flap
• Usually harvested with a cuff of muscle +/- skin to reconstruct a skeletal
framework with soft tissue
o E.g. fibula

Flaps by types of blood supply/pedicle/innervation

Fasciocutaneous

Type A – direct cutaneous pedicle

Type B – septocutaneous pedicle
Type C – musculocutaneous pedicle

Muscle Flaps by pedicle (Mathes and Nahai classification)

Type I – single pedicle

Type II – dominant pedicle with minor pedicles
Type III – dual dominant pedicles
Type IV – segmental pedicles
Type V – dominant pedicle + secondary segmental pedicles

Muscle Flaps by innervation (Taylor classification)

Type I – single, unbranched nerve entering the muscle
Type II – single nerve that braches prior to entering the muscle
Type III – multiple branches from the same nerve trunk
Type IV – multiple branches from different nerve trunks

Flaps by Technique of Transfer

Broadly: Pedicled Flaps versus Free Flaps; Local versus Distant Flaps

Local pedicled flaps:

• Advancement flap
• Rotation flap
• Transposition flap
o Z – plasty
o Rhomboid/Limberg Flap
o Double opposing semicircular flap