Plastic Surgery

Fasciocutaneous and Muscle Flaps

Fasciocutaneous Flaps

• Definition: Flaps that include a fascial component, enhancing the blood supply due to the network of subfascial, fascial, and suprafascial vessels.

Classification (Cormack and Lamberty, 1984)

1. Type A:
   • Multiple perforators (direct or indirect).
   • Example: Pontén flap.
2. Type B:
   • Single perforator, usually direct, running along the axis of the flap.
   • Example: Scapular or parascapular flaps.
3. Type C:
   • Segmental perforators arising from the same source vessel.
   • Example: Radial forearm and lateral arm flaps.
4. Type D:
   • Similar to Type C, but raised as an osteomyofasciocutaneous flap.
   • Example: Free fibular flap.

---

Muscle and Musculocutaneous Flaps

• Definition: Involves motor nerves that are accompanied by vascular pedicles, often the major source of circulation for the flap.
• Dominant pedicle: Can sustain the entire muscle.
• Minor pedicle: Can only sustain a portion of the flap.
• Skin in musculocutaneous flaps is supplied by perforators.

Classification (Mathes and Nahai, 1981)

1. Type I:
   • Single vascular pedicle.
   • Example: Tensor fascia lata, gastrocnemius.
2. Type II:
   • One dominant pedicle with one or more minor pedicles.
   • The flap cannot survive on the minor pedicles alone.
   • Example: Gracilis, biceps femoris, sternocleidomastoid, soleus, trapezius.
3. Type III:
   • Dual dominant pedicles.
   • Example: Gluteus maximus, pectoralis minor, rectus abdominis, serratus anterior, temporalis.
4. Type IV:
   • Segmental pedicles.
   • Example: Flexor hallucis longus, sartorius, tibialis anterior.
5. Type V:
   • Dominant pedicle with several smaller segmental pedicles.
   • The flap can survive on the minor pedicles alone.
   • Example: Latissimus dorsi, pectoralis major.

Classification of Muscle Flaps (Based on Blood Supply)

1. Type I: Single pedicle.
   • Example: Gastrocnemius, Tensor fascia lata.
2. Type II: Dominant pedicle with minor pedicles.
   • Example: Gracilis, Trapezius.
3. Type III: Dual dominant pedicles.
   • Example: Gluteus maximus, Serratus anterior.
4. Type IV: Segmental pedicles.
   • Example: Sartorius, Tibialis anterior.

5. Type V: Dominant pedicle with secondary segmental pedicles.

   • Example: Latissimus dorsi.

   

---

Reliability of Vascular Anatomy

• Types I, III, and V: Most useful for large muscle flaps due to their dominant pedicles.
• Type II muscles: Variable territories based on pedicle supply.
• Type IV muscles: Useful for smaller flaps.

---