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