Make a flow chart of flaps in sigery with examples and used and pedicl

Make a flow chart of flaps in sigery with examples and used and pedicles of each flaps

Reading File

Finding Sources

Reading File

Running Command

ls -la /home/daytona/workspace/ 2>/dev/null || echo "workspace empty or missing"

Running Command

mkdir -p /home/daytona/workspace/flaps-flowchart && echo "created"

Writing File

~/flaps-flowchart/flaps_flowchart.py

#!/usr/bin/env python3
"""Generate a comprehensive surgical flaps flowchart using matplotlib."""

import matplotlib
matplotlib.use('Agg')
import matplotlib.pyplot as plt
import matplotlib.patches as mpatches
from matplotlib.patches import FancyBboxPatch, FancyArrowPatch
import matplotlib.patheffects as pe
import numpy as np

# ── Colour palette ──────────────────────────────────────────────────────────
BG        = "#0D1B2A"       # near-black navy background
TITLE_BG  = "#1A3A5C"       # darker blue for title box
ROOT_BG   = "#1E6091"       # root node
LVL1_BG   = "#2980B9"       # level-1 branches
LVL2_BG   = "#1ABC9C"       # level-2 sub-branches
LVL3_BG   = "#16A085"       # leaf nodes
LEAF_BG   = "#2C3E50"       # dark leaf
ACC1      = "#E67E22"       # orange accent (blood supply)
ACC2      = "#8E44AD"       # purple accent (method of transfer)
ACC3      = "#C0392B"       # red accent (composition)
ACC4      = "#27AE60"       # green accent (contiguity)
MATHES    = "#D35400"       # Mathes-Nahai

TEXT_W    = "white"
TEXT_D    = "#ECF0F1"

ARROW_C   = "#95A5A6"

fig_w, fig_h = 34, 46
fig, ax = plt.subplots(figsize=(fig_w, fig_h))
ax.set_xlim(0, fig_w)
ax.set_ylim(0, fig_h)
ax.set_aspect('equal')
ax.axis('off')
fig.patch.set_facecolor(BG)
ax.set_facecolor(BG)


# ── Helper functions ─────────────────────────────────────────────────────────
def box(x, y, w, h, color, text, fontsize=9, textcolor=TEXT_W,
        radius=0.35, bold=False, wrap=True, alpha=1.0):
    """Draw a rounded rectangle with centred, wrapped text."""
    rect = FancyBboxPatch((x - w/2, y - h/2), w, h,
                          boxstyle=f"round,pad=0.05,rounding_size={radius}",
                          facecolor=color, edgecolor="white",
                          linewidth=0.8, alpha=alpha, zorder=3)
    ax.add_patch(rect)
    weight = 'bold' if bold else 'normal'
    ax.text(x, y, text, ha='center', va='center', fontsize=fontsize,
            color=textcolor, fontweight=weight,
            wrap=True, multialignment='center',
            zorder=4,
            bbox=dict(boxstyle='square,pad=0', fc='none', ec='none'))


def arrow(x1, y1, x2, y2, color=ARROW_C, lw=1.4):
    """Draw an arrow from (x1,y1) to (x2,y2)."""
    ax.annotate('', xy=(x2, y2), xytext=(x1, y1),
                arrowprops=dict(arrowstyle='->', color=color,
                                lw=lw, connectionstyle='arc3,rad=0.0'),
                zorder=2)


def hline(x1, x2, y, color=ARROW_C, lw=1.2):
    ax.plot([x1, x2], [y, y], color=color, lw=lw, zorder=2)


def vline(x, y1, y2, color=ARROW_C, lw=1.2):
    ax.plot([x, x], [y1, y2], color=color, lw=lw, zorder=2)


# ═══════════════════════════════════════════════════════════════════
# TITLE
# ═══════════════════════════════════════════════════════════════════
box(17, 44.5, 28, 1.6, TITLE_BG,
    "CLASSIFICATION OF FLAPS IN SURGERY",
    fontsize=20, bold=True)

# ═══════════════════════════════════════════════════════════════════
# ROOT NODE
# ═══════════════════════════════════════════════════════════════════
box(17, 42.8, 10, 1.0, ROOT_BG,
    "SURGICAL FLAP\n(Vascularised tissue transfer)",
    fontsize=11, bold=True)
arrow(17, 42.3, 17, 41.65)

# ═══════════════════════════════════════════════════════════════════
# 5 MAIN CLASSIFICATION BRANCHES  (level-1)
# X positions spread across width
# ═══════════════════════════════════════════════════════════════════
branches = [
    (4.0,  "1. BLOOD\nSUPPLY",       ACC1),
    (10.5, "2. COMPOSITION\n(Tissue type)", ACC3),
    (17.0, "3. CONTIGUITY\n(Location)",  ACC4),
    (23.5, "4. METHOD OF\nTRANSFER",   ACC2),
    (30.0, "5. MUSCLE FLAP\n(Mathes-Nahai)", MATHES),
]

y_branch = 41.0
y_root_bot = 42.3

# horizontal connector line
vline(17, 41.65, y_branch + 0.5)
hline(4.0, 30.0, y_branch + 0.5)

for bx, bt, bc in branches:
    vline(bx, y_branch + 0.5, y_branch + 0.5)
    box(bx, y_branch, 5.4, 0.9, bc, bt, fontsize=9.5, bold=True)
    arrow(bx, y_branch - 0.45, bx, y_branch - 1.0)

# ═══════════════════════════════════════════════════════════════════
# BRANCH 1 – BLOOD SUPPLY (x=4.0)
# ═══════════════════════════════════════════════════════════════════
y = 39.6
# Two sub-nodes
sub1 = [(2.0, "RANDOM PATTERN"), (6.0, "AXIAL PATTERN")]
hline(2.0, 6.0, y - 0.0)
for sx, st in sub1:
    vline(sx, y - 0.0, y - 0.35)
    box(sx, y - 0.75, 3.6, 0.7, ACC1, st, fontsize=8.5, bold=True)

# Random pattern details
yy = 38.1
box(2.0, yy, 3.6, 0.65, LEAF_BG,
    "No named A-V pedicle\nRelies on microcirculation\nLength:width ratio ≤3:1",
    fontsize=7.5)
arrow(2.0, y - 1.1, 2.0, yy + 0.33)

box(2.0, yy - 1.1, 3.6, 0.65, LEAF_BG,
    "Examples:\nZ-plasty · Rotation flap\nCross-finger flap · Thenar flap",
    fontsize=7.5)
arrow(2.0, yy - 0.33, 2.0, yy - 1.1 + 0.33)

# Axial pattern details
box(6.0, yy, 3.6, 0.65, LEAF_BG,
    "Named A-V pedicle\nMore reliable blood supply\nCan be free or pedicled",
    fontsize=7.5)
arrow(6.0, y - 1.1, 6.0, yy + 0.33)

box(6.0, yy - 1.1, 3.6, 0.65, LEAF_BG,
    "Examples:\nRadial forearm (radial a.)\nLatissimus dorsi (thoracodorsal a.)\nALT (desc. lat. fem. circ. a.)",
    fontsize=7.2)
arrow(6.0, yy - 0.33, 6.0, yy - 1.1 + 0.33)

# Perforator flap sub-type under axial
box(6.0, yy - 2.4, 3.6, 0.65, "#1F618D",
    "PERFORATOR FLAPS\n(subset of axial)\nSkin/fat supplied by\nperforator vessel",
    fontsize=7.2)
arrow(6.0, yy - 1.1 - 0.33, 6.0, yy - 2.4 + 0.33)
box(6.0, yy - 3.45, 3.6, 0.65, LEAF_BG,
    "Examples:\nDIEP (deep inf. epigastric perforator)\nALT perforator flap\nTRAM (sup. epigastric a.)",
    fontsize=7.2)
arrow(6.0, yy - 2.4 - 0.33, 6.0, yy - 3.45 + 0.33)

# ═══════════════════════════════════════════════════════════════════
# BRANCH 2 – COMPOSITION (x=10.5)
# ═══════════════════════════════════════════════════════════════════
comp_items = [
    ("CUTANEOUS", "Skin + subcutaneous fat\nPedicle: subdermal plexus\nEx: Thenar, cross-finger flap"),
    ("FASCIOCUTANEOUS", "Fascia + skin\nPedicle: fascial plexus vessels\nEx: Radial forearm, ALT, Lateral arm\nScapular flap"),
    ("MUSCULOCUTANEOUS", "Muscle + overlying skin\nPedicle: dominant muscle\npedicle (see Mathes-Nahai)\nEx: TRAM, Latissimus dorsi,\nPectoralis major, Gracilis"),
    ("MUSCLE ONLY", "Bare muscle flap\n(skin graft applied after)\nPedicle: dominant muscle artery\nEx: Gastrocnemius, Soleus,\nSerratus anterior"),
    ("OSTEOCUTANEOUS", "Bone + soft tissue\nPedicle: periosteal vessels\nEx: Free fibula (peroneal a.)\nIliac crest (deep circ. iliac a.)\nScapula (circumflex scapular a.)"),
    ("OMENTUM /\nVISCERAL", "Omentum or bowel\nPedicle: gastroepiploic a. (omentum)\nEx: Omental flap, Jejunal flap"),
]

y_top = 39.3
y_step = 1.55
x_comp = 10.5
vline(x_comp, y_branch - 0.45, y_top + 0.33)

for i, (title, detail) in enumerate(comp_items):
    yc = y_top - i * y_step
    box(x_comp, yc, 5.0, 0.55, ACC3, title, fontsize=8, bold=True)
    arrow(x_comp, yc - 0.28, x_comp, yc - 0.6)
    box(x_comp, yc - 0.95, 5.0, 0.65, LEAF_BG, detail, fontsize=7)
    if i < len(comp_items) - 1:
        arrow(x_comp, yc - 1.28, x_comp, y_top - (i+1)*y_step + 0.28)

# Cormack-Lamberty sub-box for fasciocutaneous
cl_y = y_top - 1*y_step - 0.95 - 0.7
box(x_comp, cl_y, 5.0, 0.85,
    "#7D3C98",
    "Cormack-Lamberty Classification:\nType A: multiple perforators (Pontén flap)\nType B: single perforator (Scapular flap)\nType C: segmental (Radial forearm, Lat. arm)\nType D: osteomyofasciocutaneous (Free fibula)",
    fontsize=6.8)
arrow(x_comp, y_top - 1*y_step - 0.95 + 0.33, x_comp, cl_y + 0.43)

# ═══════════════════════════════════════════════════════════════════
# BRANCH 3 – CONTIGUITY (x=17.0)
# ═══════════════════════════════════════════════════════════════════
cont_data = [
    ("LOCAL FLAP", ACC4,
     "Shares border with defect\nNeighbouring tissue\nBest colour/texture match",
     "Rotation flap\nAdvancement flap\nTransposition flap\nZ-plasty\nRhomboid (Limberg) flap\nBilobed flap"),
    ("REGIONAL FLAP", "#1E8449",
     "Near but not adjacent to defect\nPedicled transfer",
     "Pectoralis major flap\nLatissimus dorsi flap\nGastrocnemius flap (knee)\nSoleus flap (mid-leg)\nDeltopectoral flap"),
    ("DISTANT FLAP", "#145A32",
     "Far from defect\nPedicled or free transfer\nRequires 2-stage or\nmicrovascular anastomosis",
     "Groin flap (superficial\ncircumflex iliac a.)\nAbdominal pocket flap\nFree flaps (microvascular)\nCross-leg flap"),
]

y_cont = 39.3
x_cont = 17.0
vline(x_cont, y_branch - 0.45, y_cont + 0.33)
hline(x_cont - 0.5, x_cont + 0.5, y_cont + 0.33)

y_step_c = 2.8
for i, (title, col, props, exs) in enumerate(cont_data):
    yc = y_cont - i * y_step_c
    box(x_cont, yc, 5.2, 0.6, col, title, fontsize=9, bold=True)
    arrow(x_cont, yc - 0.30, x_cont, yc - 0.62)
    box(x_cont, yc - 1.0, 5.2, 0.65, LEAF_BG, props, fontsize=7.5)
    arrow(x_cont, yc - 1.33, x_cont, yc - 1.65)
    box(x_cont, yc - 2.05, 5.2, 0.7, "#1C2833", "Examples:\n" + exs, fontsize=7.2)
    if i < len(cont_data) - 1:
        arrow(x_cont, yc - 2.4, x_cont, y_cont - (i+1)*y_step_c + 0.30)

# ═══════════════════════════════════════════════════════════════════
# BRANCH 4 – METHOD OF TRANSFER (x=23.5)
# ═══════════════════════════════════════════════════════════════════
transfer_data = [
    ("ADVANCEMENT", ACC2,
     "Moves in a straight line\ninto the defect",
     "V-Y flap\nMoberg flap (thumb)\nBipedicle advancement flap"),
    ("ROTATION", "#6C3483",
     "Semicircular flap pivoted\ninto defect\nRandom pattern",
     "Scalp rotation flap\nBack-cut rotation flap\nO-to-Z plasty"),
    ("TRANSPOSITION", "#5B2C6F",
     "Lifted over intervening skin\nMay be axial or random",
     "Rhomboid (Limberg) flap\nBilobed flap\nBanner flap\nNote flap"),
    ("INTERPOLATION\n(Staged)", "#4A235A",
     "Pedicle crosses/lies over\nnormal skin; divided later",
     "Paramedian forehead flap\n(supratrochlear a.)\nAbdominoplasty flap\nCross-leg flap"),
    ("FREE FLAP\n(Microsurgical)", "#7B241C",
     "Pedicle divided; vessels\nreanastomosed at recipient site\nRequires microvascular surgery",
     "Radial forearm free flap (radial a.)\nFibula free flap (peroneal a.)\nALT free flap (desc. LFCA)\nDIEP flap (deep inf. epigastric a.)\nGracilis free flap (med. fem. circ. a.)\nJejunum free flap (SMA branch)\nLatissimus dorsi free flap\n(thoracodorsal a.)"),
]

y_trans = 39.3
x_trans = 23.5
vline(x_trans, y_branch - 0.45, y_trans + 0.33)

y_step_t = 2.2
for i, (title, col, props, exs) in enumerate(transfer_data):
    yc = y_trans - i * y_step_t
    box(x_trans, yc, 5.2, 0.6, col, title, fontsize=8.5, bold=True)
    arrow(x_trans, yc - 0.30, x_trans, yc - 0.62)
    box(x_trans, yc - 1.05, 5.2, 0.62, LEAF_BG, props, fontsize=7.5)
    arrow(x_trans, yc - 1.36, x_trans, yc - 1.62)
    box(x_trans, yc - 2.0, 5.2, 0.68, "#1C2833", "Examples:\n" + exs, fontsize=7.0)
    if i < len(transfer_data) - 1:
        arrow(x_trans, yc - 2.34, x_trans, y_trans - (i+1)*y_step_t + 0.30)

# ═══════════════════════════════════════════════════════════════════
# BRANCH 5 – MATHES-NAHAI (x=30.0)
# ═══════════════════════════════════════════════════════════════════
mathes_data = [
    ("TYPE I",   "1 vascular pedicle",
     "Gastrocnemius (sural a.)\nTensor fascia lata\n(lat. fem. circ. a.)"),
    ("TYPE II",  "1 dominant + minor pedicles\n(cannot survive on minor alone)",
     "Gracilis (med. fem. circ. a.)\nSoleus (popliteal a.)\nTrapezius (transverse cerv. a.)"),
    ("TYPE III", "2 dominant pedicles",
     "Rectus abdominis\n(sup. + inf. epigastric a.)\nGluteus maximus\nSerratus anterior\nTemporalis"),
    ("TYPE IV",  "Segmental pedicles\n(no dominant; sacrifice = necrosis)",
     "Sartorius\nTibialis anterior\nFlexor hallucis longus"),
    ("TYPE V",   "1 dominant + secondary\nsegmental pedicles\n(can survive on secondary alone)",
     "Latissimus dorsi (thoracodorsal a.)\nPectoralis major (thoracoacromial a.)"),
]

y_math = 39.3
x_math = 30.0
vline(x_math, y_branch - 0.45, y_math + 0.33)

y_step_m = 2.15
for i, (title, supply, exs) in enumerate(mathes_data):
    yc = y_math - i * y_step_m
    box(x_math, yc, 5.2, 0.6, MATHES, title, fontsize=9, bold=True)
    arrow(x_math, yc - 0.30, x_math, yc - 0.62)
    box(x_math, yc - 1.0, 5.2, 0.62, "#784212", supply, fontsize=7.8)
    arrow(x_math, yc - 1.31, x_math, yc - 1.6)
    box(x_math, yc - 2.0, 5.2, 0.65, "#1C2833", exs, fontsize=7.3)
    if i < len(mathes_data) - 1:
        arrow(x_math, yc - 2.33, x_math, y_math - (i+1)*y_step_m + 0.30)

# ═══════════════════════════════════════════════════════════════════
# LEGEND
# ═══════════════════════════════════════════════════════════════════
legend_x, legend_y = 1.2, 3.5
box(legend_x + 1.5, legend_y + 0.5, 3.5, 0.5, BG, "LEGEND", fontsize=9, bold=True, textcolor=TEXT_D)

legend_items = [
    (ACC1,    "Blood Supply classification"),
    (ACC3,    "Composition / Tissue type"),
    (ACC4,    "Contiguity / Location"),
    (ACC2,    "Method of Transfer"),
    (MATHES,  "Mathes-Nahai (Muscle types)"),
    ("#7D3C98", "Cormack-Lamberty (Fasciocutaneous)"),
    (LEAF_BG, "Properties / Notes"),
    ("#1C2833", "Clinical Examples"),
]

for j, (col, label) in enumerate(legend_items):
    lx = legend_x
    ly = legend_y - j * 0.38
    rect = FancyBboxPatch((lx, ly - 0.12), 0.5, 0.24,
                          boxstyle="round,pad=0.02",
                          facecolor=col, edgecolor='white', lw=0.6, zorder=5)
    ax.add_patch(rect)
    ax.text(lx + 0.65, ly, label, va='center', fontsize=8,
            color=TEXT_D, zorder=6)

# Source citation
ax.text(17, 0.5,
        "Sources: Bailey & Love's Surgery 28e · Schwartz's Principles 11e · Miller's Orthopaedics 9e · Sabiston Surgery",
        ha='center', va='center', fontsize=7.5, color="#7F8C8D",
        style='italic', zorder=6)

plt.tight_layout(pad=0.3)
plt.savefig('/home/daytona/workspace/flaps-flowchart/flaps_flowchart.png',
            dpi=150, bbox_inches='tight', facecolor=BG)
print("Saved.")

Running Command

cd /home/daytona/workspace/flaps-flowchart && python3 flaps_flowchart.py 2>&1

Running Command

ls -lh /home/daytona/workspace/flaps-flowchart/

Reading File

The file is ready. Here is your comprehensive surgical flaps flowchart:

Flowchart of Flaps in Surgery

flaps flowchart

Image · PNG

The flowchart covers 5 classification branches flowing from a single root node. Here's the full breakdown in text form as well:

SURGICAL FLAP - Master Classification

1. BY BLOOD SUPPLY (Circulation)

Type	Features	Pedicle	Examples
Random Pattern	No named A-V pedicle; relies on subdermal microcirculation; length:width ratio ≤3:1	Dermal/subdermal plexus	Z-plasty, rotation flap, cross-finger flap, thenar flap
Axial Pattern	Single named arteriovenous pedicle; predictable blood supply; can be free or pedicled	Named artery + paired vein	Radial forearm (radial a.), latissimus dorsi (thoracodorsal a.), ALT (descending lateral femoral circumflex a.)
Perforator Flap (subset of axial)	Skin/fat supplied by isolated perforator; spares underlying muscle	Perforator vessel from deep source artery	DIEP (deep inferior epigastric perforator), ALT perforator, TRAM (superior epigastric a.)

2. BY COMPOSITION (Tissue Type)

Type	Components	Pedicle	Examples
Cutaneous	Skin + subcutaneous fat	Subdermal plexus	Thenar flap, cross-finger flap
Fasciocutaneous	Fascia + skin (±subcutaneous tissue)	Fascial plexus vessels	Radial forearm, ALT, lateral arm, scapular flap
Musculocutaneous	Muscle + overlying skin + fascia	Dominant muscle pedicle	TRAM, latissimus dorsi, pectoralis major, gracilis
Muscle only	Bare muscle (skin graft applied after)	Dominant muscle artery	Gastrocnemius, soleus, serratus anterior
Osteocutaneous	Bone + overlying soft tissue	Periosteal/nutrient vessels	Free fibula (peroneal a.), iliac crest (deep circ. iliac a.), scapula (circumflex scapular a.)
Omentum/Visceral	Omentum or bowel	Gastroepiploic a. / SMA branch	Omental flap, jejunal free flap

Cormack-Lamberty Classification of Fasciocutaneous Flaps:

Type A - multiple perforators (e.g., Pontén flap)
Type B - single perforator along flap axis (e.g., scapular flap)
Type C - segmental perforators from same source vessel (e.g., radial forearm, lateral arm)
Type D - osteomyofasciocutaneous version of Type C (e.g., free fibula)

3. BY CONTIGUITY (Location)

Type	Definition	Examples
Local	Shares a border with defect; best colour/texture match	Rotation, advancement, transposition, Z-plasty, rhomboid (Limberg), bilobed
Regional	Near but not adjacent to defect; pedicled transfer	Pectoralis major, latissimus dorsi, gastrocnemius (proximal tibia), soleus (mid-leg), deltopectoral
Distant	Far from defect; pedicled or free; may need 2 stages	Groin flap (superficial circumflex iliac a.), abdominal pocket flap, cross-leg flap, all free flaps

4. BY METHOD OF TRANSFER (Contour/Movement)

Method	Mechanism	Examples
Advancement	Slides in straight line into defect	V-Y flap, Moberg flap (thumb tip), bipedicle advancement
Rotation	Semicircular flap pivoted into defect; always random	Scalp rotation, back-cut rotation, O-to-Z plasty
Transposition	Lifted over intervening skin; axial or random	Rhomboid (Limberg), bilobed, banner, note flap
Interpolation (staged)	Pedicle crosses normal skin; divided at 2nd stage	Paramedian forehead flap (supratrochlear a.), abdominal flap
Free Flap (microsurgical)	Pedicle divided; vessels reanastomosed at recipient site	Radial forearm (radial a.), fibula (peroneal a.), ALT (desc. LFCA), DIEP, gracilis (medial femoral circumflex a.), jejunum (SMA branch)

5. MATHES-NAHAI MUSCLE FLAP CLASSIFICATION

Type	Vascular Supply	Pedicle	Key Examples
Type I	1 vascular pedicle	Single dominant	Gastrocnemius (sural a.), tensor fascia lata (lateral femoral circumflex a.)
Type II	1 dominant + minor pedicles (cannot survive on minor alone)	Dominant + minor	Gracilis (medial femoral circumflex a.), soleus (popliteal a.), trapezius (transverse cervical a.)
Type III	2 dominant pedicles	Two dominant	Rectus abdominis (superior + inferior epigastric a.), gluteus maximus, serratus anterior, temporalis
Type IV	Segmental pedicles (no dominant; ligation causes necrosis)	Multiple segmental	Sartorius, tibialis anterior, flexor hallucis longus
Type V	1 dominant + secondary segmental pedicles (can survive on secondary alone)	Dominant + secondary segmental	Latissimus dorsi (thoracodorsal a.), pectoralis major (thoracoacromial a.)

Sources: Bailey & Love's Short Practice of Surgery 28e - Schwartz's Principles of Surgery 11e - Miller's Review of Orthopaedics 9e - Sabiston Textbook of Surgery

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