ABSTRACT
Dominant pedicles: superficial temporal and occipital arteries and veins
Minor pedicles: supratrochlear, supraorbital, and posterior auricular arteries and veins
4. Innervation: supratrochlear, auriculotemporal, postauricular, greater and lesser occipital, great auricular, and third cervical nerves (sensory)
B. Temporoparietal Fascia Flap
1. Flap type: fascial
2. Pattern of circulation: Type A
3. Vascular anatomy:
Dominant pedicle: superficial temporal artery and vein
4. Innervation: auriculotemporal nerve (sensory)
C. Temporalis Muscle Flap
1. Flap type: muscle, musculofascial, musculocutaneous
2. Pattern of circulation: Type III
3. Vascular anatomy:
Dominant pedicle: deep temporal artery and vein
Minor pedicles: branches of middle temporal artery and vein
4. Innervation: fifth cranial nerve (motor)
D. Median Forehead Flap
1. Flap type: fasciocutaneous
2. Pattern of circulation: Type C
3. Vascular anatomy:
Dominant pedicle: supratrochlear artery and venae comitantes
Minor pedicles: supraorbital artery and venae comitantes
4. Innervation: supratrochlear and supraorbital nerves (sensory)
E. Standard Forehead Flap
1. Flap type: fasciocutaneous
2. Pattern of circulation: Type A
3. Vascular anatomy:
Dominant pedicle: superficial temporal artery and vein
Minor pedicles: supratrochlear and supraorbital arteries and venae comitantes
4. Innervation: supratrochlear, supraorbital, and auriculotemporal nerves (sensory)
F. Nasolabial Flap
1. Flap type: fasciocutaneous
2. Pattern of circulation: Type C
3. Vascular anatomy:
Dominant pedicle: angular artery and vein Minor pedicle: alar branches of superior labial
artery
4. Innervation: trigeminal nerve (sensory)
G. Orbicularis Oris Flap
1. Basis for Abbe flap and Estlander flap
2. Flap type: Muscle, musculocutaneous, musculomucocutaneous
3. Pattern of circulation: Type III
4. Vascular anatomy:
Dominant pedicle: superior (upper lip) or
Minor pedicle: medial branch of inferior alveolar artery (lower lip)
5. Innervation: facial nerve (motor); trigeminal nerve (sensory)
H. Facial Artery Musculomucosal (FAMM) Flap
1. Flap type: musculomucosal
2. Pattern of circulation: Type II
3. Vascular anatomy:
Dominant pedicles: facial artery, venous plexuses draining to pterygoid plexus, internalmaxillary vein posteriorly and facial vein anteriorly
Minor pedicles: angular artery and vein, branches of superior labial artery and vein
4. Innervation: supratrochlear, auriculotemporal, postauricular, greater and lesser occipital, great auricular, and third cervical nerves (sensory)
III. CHEST AND BACK FLAPS
A. Deltopectoral Flap
1. Flap type: fasciocutaneous
2. Pattern of circulation: Type C
3. Vascular anatomy:
Dominant pedicle: 2nd and 3rd perforating branches of internal mammary artery
Minor pedicles: 1st and 4th perforating branches of internal mammary artery
4. Innervation: 2nd to 4th intercostal nerves (sensory)
B. Pectoralis Major Flap
1. Flap type: muscle, musculocutaneous, osteomusculocutaneous
2. Pattern of circulation: Type V
3. Vascular anatomy:
Dominant pedicle: pectoral branch of thoracoacromial artery and venae comitantes
Minor pedicles: pectoral branch of lateral thoracic artery, perforators from internalmammary and intercostal arteries, and venae comitantes
4. Innervation: lateral pectoral nerve and branches from medial pectoral nerve (motor); 2nd to 7th
C. Pectoralis Minor Flap
1. Flap type: muscle
2. Pattern of circulation: Type III
3. Vascular anatomy:
Dominant pedicle: pectoral branch of thoracoacromial artery and branch of lateral thoracicartery
Minor pedicle: branch from axillary artery
4. Innervation: medial and lateral pectoral nerves (motor)
D. Trapezius Flap
1. Flap type: muscle or musculocutaneous
2. Pattern of circulation: Type II
3. Vascular anatomy:
Dominant pedicle: ascending and descending branches of transverse cervical artery and vein
Minor pedicles: branch of occipital artery and vein; dorsal scapular artery and vein; perforators fromposterior intercostal artery andvein
4. Innervation: spinal accessory nerve (motor); 3rd and 4th cervical nerves and branches from posterior intercostal nerves (sensory)
E. Scapular Flap
1. Flap type: fasciocutaneous
2. Pattern of circulation: Type B
3. Vascular anatomy:
Dominant pedicle: circumflex scapular artery and vein
4. Innervation: lateral and posterior cutaneous nerves from 3rd to 5th intercostal nerves (sensory)
F. Latissimus Dorsi Flap
1. Flap type: muscle or musculocutaneous
2. Pattern of circulation: Type V
3. Vascular anatomy:
Dominant pedicle: thoracodorsal artery and vein
Minor pedicles: 4-6 perforators from posterior intercostal arteries and lumbar artery and
4. Innervation: thoracodorsal nerve (motor); posterior branches from intercostal nerves (sensory)
G. Serratus Anterior Flap
1. Flap type: muscle, musculocutaneous, or osteomusculocutaneous flap
2. Pattern of circulation: Type III
3. Vascular anatomy:
Dominant pedicles: lateral thoracic artery and branches from thoracodorsal artery
4. Innervation: long thoracic nerve (motor); T2-T4 intercostal nerves (sensory)
IV. UPPER EXTREMITY FLAPS
A. Deltoid Flap
1. Flap type: fasciocutaneous
2. Pattern of circulation: Type B
3. Vascular anatomy:
Dominant pedicle: posterior deltoid subcutaneous artery from the posterior circumflex humeral artery
4. Innervation: lateral cutaneous branch of circumflex humeral nerve (sensory)
B. Lateral Arm Flap
1. Flap type: fascial and fasciocutaneous
2. Pattern of circulation: Type B
3. Vascular anatomy:
Dominant pedicle: posterior radial collateral artery and venae comitantes (branch of the profunda brachii artery)
Minor pedicle: radial recurrent artery
4. Innervation: posterior cutaneous nerve of the arm (sensory)
C. Posterior Interosseous Artery Flap
1. Flap type: fasciocutaneous
2. Pattern of circulation: Type B
3. Vascular anatomy:
Dominant pedicle: posterior interosseous artery and venae comitantes
Minor pedicle: anterior interosseous artery and
4. Innervation: branch of dorsal antebrachial cutaneous nerve and medial antebrachial cutaneous nerve (sensory)
D. Radial Forearm Flap
1. Flap type: fasciocutaneous and osteoseptocutaneous
2. Pattern of circulation: Type B
3. Vascular anatomy:
Dominant pedicle: radial artery, venae comitantes, and cephalic vein
4. Innervation: medial and lateral antebrachial cutaneous nerves (sensory)
E. Ulnar Artery Forearm Flap
1. Flap type: fasciocutaneous and osteoseptocutaneous
2. Pattern of circulation: Type B
3. Vascular anatomy:
Dominant pedicle: ulnar artery, venae comitantes, and basilic vein
4. Innervation: medial antebrachial cutaneous nerve (sensory)
F. Dorsal Metacarpal Artery Flap
1. A fasciocutaneous flap thatmay be elevated from any finger based on any of the dorsal metacarpal arteries (usually elevated from the index or middle fingers)
2. Flap type: fasciocutaneous
3. Pattern of circulation: Type A
4. Vascular anatomy:
Dominant pedicle: dorsal metacarpal artery
5. Innervation: dorsal sensory branches of radial and ulnar nerves (sensory)
G. First Dorsal Interosseous Flap
1. In contrast to the dorsal metacarpal artery fasciocutaneous flap, a muscle flap (1st dorsal interosseous muscle) based on the first dorsal metacarpal artery
2. Flap type: muscle
3. Pattern of circulation: Type I
4. Vascular anatomy:
Dominant pedicle: first dorsal metacarpal artery and venae comitantes
5. Innervation: deep palmar branch of ulnar nerve (sensory)
H. Digital Artery Flap
1. Flap type: fasciocutaneous
2. Pattern of circulation: Type A
3. Vascular anatomy:
Dominant pedicle: digital artery
4. Innervation: digital nerve branches of median and ulnar nerves (sensory)
V. ABDOMINAL AND GROIN FLAPS
A. Rectus Abdominis Flap
1. Flap type: muscle and musculocutaneous
2. Pattern of circulation: Type III
3. Vascular anatomy:
Dominant pedicles: deep inferior and superior epigastric arteries and veins
Minor pedicles: subcostal and intercostal arteries and venae comitantes
4. Innervation: 7th to 12th intercostal nerves (motor); lateral cutaneous nerves from 7th to 12th intercostal nerves (sensory)
B. Superficial Inferior Epigastric Artery Flap
1. Flap type: fasciocutaneous
2. Pattern of circulation: Type A
3. Vascular anatomy:
Dominant pedicle: superficial inferior epigastric artery and vein
4. Innervation: 10th to 12th intercostal nerves (sensory)
C. External Oblique Flap
1. Flap type: muscle or musculocutaneous
2. Pattern of circulation: Type IV
3. Vascular anatomy:
Segmental pedicles-lateral cutaneous branches of inferior 8 posterior intercostal arteries and venae comitantes
4. Innervation: 7th to 12th intercostal nerves (motor); T3 to T11 lateral cutaneous nerves (sensory)
D. Internal Oblique Flap
1. Flap type: muscle
2. Pattern of circulation: Type V
3. Vascular anatomy:
Dominant pedicle: ascending branch of deep circumflex iliac artery and vein
Minor pedicles: lateral branches of deep inferior epigastric vessels
4. Innervation: T8 to T12 (sensory)
E. Deep Circumflex Iliac Artery Flap
1. Flap type: musculo-osseous, musculocutaneous, osteomusculocutaneous
2. Pattern of circulation: Type I
3. Vascular anatomy:
Dominant pedicle: deep circumflex iliac artery and vein
4. Innervation: T12 (sensory)
F. Groin Flap
1. Flap type: fasciocutaneous
2. Pattern of circulation: Type A
3. Vascular anatomy:
Dominant pedicle: superficial circumflex iliac artery and venae comitantes
4. Innervation: lateral cutaneous nerve of T12 (sensory)
G. Pudendal Flap
1. Flap type: fasciocutaneous
2. Pattern of circulation: Type A
3. Vascular anatomy:
Dominant pedicle: posterior labial artery and
4. Innervation: pudendal nerve (sensory)
H. Omental Flap
1. Flap type: omentum
2. Pattern of circulation: Type III
3. Vascular anatomy:
Dominant pedicle: right and left gastroepiploic artery and vein
I. Jejunal Flap
1. Flap type: small intestine
2. Pattern of circulation: type I
3. Vascular anatomy:
Dominant pedicle: jejunal artery and accompanying vein
J. Colon Flap
1. Flap type: large intestine
2. Pattern of circulation: Type I
3. Vascular anatomy:
Dominant pedicle: middle colic artery and vein
VI. BUTTOCK AND THIGH FLAPS
A. Gluteus Maximus Flap
1. Flap type: muscle or musculocutaneous
2. Pattern of circulation: Type III
3. Vascular anatomy:
Dominant pedicle: superior and inferior gluteal artery and vein
4. Innervation: inferior gluteal nerve (motor); posterior cutaneous nerve and branches from S1-3 and L1-3 (sensory)
B. Anterolateral Thigh Flap
1. Flap type: fasciocutaneous
2. Pattern of circulation: Type B and C
3. Vascular anatomy:
Dominant pedicles: septocutaneous branches of descending branch of lateral circumflex
Minor pedicles: musculocutaneous branches of descending and transverse branches of lateral circumflex femoral artery
4. Innervation: lateral femoral cutaneous nerve (sensory)
C. Lateral Thigh Flap
1. Flap type: fasciocutaneous
2. Pattern of circulation: Type B
3. Vascular anatomy:
Dominant pedicles: 1st, 2nd, and 3rd perforators of profunda femoris artery and vein
4. Innervation: lateral cutaneous nerve of thigh (sensory)
D. Medial Thigh Flap
1. Flap type: fasciocutaneous
2. Pattern of circulation: Type B
3. Vascular anatomy:
Dominant pedicle: anterior septocutaneous artery and vein from superficial femoral artery
4. Innervation: medial anterior cutaneous nerve of thigh (sensory)
E. Sartorius Flap
1. Flap type: muscle or musculocutaneous
2. Pattern of circulation: Type IV
3. Vascular anatomy:
Segmental pedicles: branches of superficial femoral artery and vein
4. Innervation: femoral nerve (motor)
F. Rectus Femoris Flap
1. Flap type: muscle
2. Pattern of circulation: Type II
3. Vascular anatomy:
Dominant pedicle: descending branch of lateral circumflex femoral artery and vein
Minor pedicles: ascending branch of lateral circumflex femoral vessels and branches of superficial femoral vessels
G. Vastus Lateralis Flap
1. Flap type: muscle and musculocutaneous
2. Pattern of circulation: Type I
3. Vascular anatomy:
Dominant pedicle: descending branch of lateral circumflex femoral artery and vein
4. Innervation: femoral nerve (motor); lateral femoral cutaneous nerve (sensory)
H. Vastus Medialis Flap
1. Flap type: muscle and musculocutaneous
2. Pattern of circulation: Type II
3. Vascular anatomy:
Dominant pedicle: branch of superficial femoral artery and vein
Minor pedicles: branches of descending genicular artery and vein
4. Innervation: femoral nerve (motor); saphenous nerve (sensory)
I. Gracilis Flap
1. Flap type: muscle or musculocutaneous
2. Pattern of circulation: Type II
3. Vascular anatomy:
Dominant pedicle: ascending branch of medial circumflex femoral artery and vein
Minor pedicles: branches from superficial femoral artery and vein
4. Innervation: anterior branch of obturator nerve (motor); anterior femoral cutaneous nerve (sensory)
J. Tensor Fascia Lata Flap
1. Flap type: muscle, musculocutaneous, musculofascial
2. Pattern of circulation: Type I
3. Vascular anatomy:
Dominant pedicle: ascending branch of lateral circumflex femoral artery and vein
4. Innervation: superior gluteal nerve (motor);
K. Biceps Femoris Flap
1. Flap type: muscle and musculocutaneous
2. Pattern of circulation: Type II
3. Vascular anatomy:
Dominant pedicle: 1st to 3rd perforating branches of profunda femoris artery and vein
Minor pedicles: branches from inferior gluteal artery and vein and superior lateral genicular artery and vein
4. Innervation: branches of sciatic nerve (motor); posterior cutaneous nerve of the thigh (sensory)
VII. LEG AND FOOT FLAPS
A. Anterior Tibial Artery Flap
1. Flap type: fasciocutaneous
2. Pattern of circulation: Type B
3. Vascular anatomy:
Dominant pedicle: septocutaneous branches of anterior tibial artery and vein
4. Innervation: common peroneal nerve (sensory)
B. Tibialis Anterior Muscle Flap
1. Flap type: muscle
2. Pattern of circulation: Type IV
3. Vascular anatomy:
Segmental pedicles: branches of anterior tibial artery and vein
4. Innervation: deep peroneal nerve (motor)
C. Fibula Flap
1. Flap type: osseous and osteofasciocutaneous
2. Pattern of circulation: Type IV
3. Vascular anatomy:
Dominant pedicle: nutrient artery and vein from peroneal vessels
Minor pedicles: periosteal and muscular branches from peroneal vessels
4. Innervation: superficial peroneal nerve (sensory)
D. Extensor Hallucis Longus Flap
2. Pattern of circulation: Type IV
3. Vascular anatomy:
Segmental pedicles: 6-8 branches from anterior tibial vessels
4. Innervation: deep peroneal nerve (motor)
E. Extensor Digitorum Longus Flap
1. Flap type: muscle
2. Pattern of circulation: Type IV
3. Vascular anatomy:
Segmental pedicles: 8-10 branches from anterior tibial vessels
4. Innervation: deep peroneal nerve (motor)
F. Gastrocnemius Flap
1. Flap type: muscle and musculocutaneous
2. Pattern of circulation: Type I
3. Vascular anatomy:
Dominant pedicle: medial sural artery and vein (medial head); lateral sural artery and vein (lateral head)
4. Innervation: tibial nerve branches (motor); saphenous nerve for medial head and sural nerve for lateral head (sensory)
G. Soleus Flap
1. Flap type: muscle and musculocutaneous
2. Pattern of circulation: Type II
3. Vascular anatomy:
Dominant pedicles: branches from popliteal artery and vein, posterior tibial artery and vein, and peroneal artery and vein
Minor pedicles: branches from posterior tibial artery and vein
4. Innervation: tibial and medial popliteal nerves (motor)
H. Sural Artery Flap
1. Flap type: fasciocutaneous
3. Vascular anatomy:
Dominant pedicle: direct cutaneous branch from sural artery and lesser saphenous vein
4. Innervation: medial sural cutaneous nerve (sensory)
I. Dorsalis Pedis Flap
1. Flap type: fasciocutaneous
2. Pattern of circulation: Type B
3. Vascular anatomy:
Dominant pedicles: septocutaneous perforators from dorsalis pedis artery and first dorsal metatarsal artery, venae comitantes, and long and short saphenous veins
4. Innervation: branches of deep and superficial peroneal nerves (sensory)
J. Extensor Digitorum Brevis Flap
1. Flap type: muscle
2. Pattern of circulation: Type II
3. Vascular anatomy:
Dominant pedicle: lateral tarsal branch of dorsal pedis artery and venae comitantes
4. Innervation: lateral tarsal branches of deep peroneal nerve (motor)
K. Abductor Hallucis Flap
1. Flap type: muscle and musculocutaneous
2. Pattern of circulation: Type II
3. Vascular anatomy:
Dominant pedicle: proximal branch of medial plantar artery and vein
Minor pedicles: branches from medial plantar vessels
4. Innervation: medial plantar nerve (motor); medial plantar nerve (sensory)
L. Abductor Digiti Minimi Flap
1. Flap type: muscle and musculocutaneous
2. Pattern of circulation: Type II
3. Vascular anatomy:
Dominant pedicle: proximal branch from lateral plantar artery and vein
Minor pedicles: muscular branches from lateral plantar vessels
4. Innervation: lateral plantar nerve (motor); lateral plantar nerve and branches of sural nerve (sensory)
M. Lateral Plantar Artery Flap
1. Flap type: fasciocutaneous
2. Pattern of circulation: Type B
3. Vascular anatomy:
Dominant pedicle: calcaneal branches of lateral plantar artery
4. Innervation: medial calcaneal branches of tibial nerve (sensory)
N. Medial Plantar Artery Flap
1. Flap type: fasciocutaneous
2. Pattern of circulation: Type B
3. Vascular anatomy:
Dominant pedicle: medial plantar artery and vein
Minor pedicles: perforating branches from abductor hallucis and flexor digitorum brevis muscles
4. Innervation: medial plantar nerve (sensory)
O. Great Toe Free Flap
1. Flap type: composite tissue
2. Pattern of circulation: Type A
3. Vascular anatomy:
Dominant pedicle: first dorsal metatarsal artery and venae comitantes
Minor pedicles: first plantar metatarsal artery and venae comitantes
4. Innervation: medial dorsal cutaneous nerve from superficial peroneal nerve, terminal branch of deep peroneal nerve, proper digital nerve and common digital nerve (sensory)
