Classification of Flaps Based on Blood Supply and Methods of Movement Flaps are tissue grafts used in reconstructive surgery to replace or repair damaged or missing tissue. They can be classified based on their blood supply and the methods used to transfer them to the recipient site. Classification Based on Blood Supply: 1. Random Pattern Flaps: o Blood Supply: These flaps rely on the subdermal plexus of blood vessels within the tissue. The blood supply is not predetermined or specifically identified before flap elevation. o Characteristics: They are simpler in design and can be raised without detailed vascular anatomy knowledge. However, their survival can be less predictable due to the variability in blood supply. o Examples: Rotation flaps, advancement flaps. 2. Axial Pattern Flaps: o Blood Supply: These flaps have a defined dominant vascular pedicle that supplies the tissue. The vascular anatomy is well-defined before flap elevation. o Characteristics: They have a more reliable blood supply and are capable of larger movements due to the preservation of vascular integrity. o Examples: Deltopectoral flap, groin flap, radial forearm flap. 3. Free Flaps (Microvascular Flaps): o Blood Supply: These flaps are completely detached from their original blood supply and require microsurgical techniques to reattach them to blood vessels at the recipient site. o Characteristics: They offer versatility in flap selection and can be used for complex reconstructions where local tissues are not suitable. o Examples: Fibula flap, radial forearm flap with microvascular anastomosis. Classification Based on Methods of Movement: 1. Local Flaps: o Movement: These flaps are moved from an adjacent area to cover the defect without extensive mobilization. o Advantages: They preserve local tissue characteristics and can be performed relatively quickly. o Examples: Rotation flaps, advancement flaps, transposition flaps. 2. Regional Flaps: o Movement: These flaps involve movement of tissue from a nearby but not directly adjacent region to cover the defect. Advantages: They provide greater reach and can cover larger defects compared to local flaps. o Examples: Deltopectoral flap, groin flap, temporalis muscle flap. 3. Distant Flaps: o Movement: These flaps are transferred from a distant part of the body to the recipient site. o Advantages: They are useful for complex reconstructions where local or regional options are inadequate. o Examples: Free flaps (fibula flap, radial forearm flap), distant pedicled flaps. o Choosing the Appropriate Flap: • • • Defect Size and Location: The size and location of the defect influence flap selection. Local flaps are preferred for smaller defects, while larger defects may require regional or distant flaps. Vascular Status: The vascular status of the recipient site and flap donor site determines the feasibility of microvascular flaps versus pedicled flaps. Functional and Aesthetic Considerations: Flap selection also considers functional outcomes (e.g., maintaining mobility or sensation) and aesthetic outcomes (e.g., matching skin color and texture). In conclusion, understanding the classification of flaps based on blood supply and methods of movement is essential for planning reconstructive surgery. Each type of flap offers distinct advantages and considerations, impacting the success and outcome of surgical reconstruction.