Skin Flaps

To improve the reader's understanding of flap classification, the author has summarized the most commonly used classifications into 3 simplified categories: type of blood supply, type of tissue to be transferred, and location of donor site.
Blood supply:
The classification of flaps based on blood supply, including the Mathes and Nahai subclassification, can be summarized as follows:

• Random (no named blood vessel)
• Axial (named blood vessel) Mathes and Nahai classification
  • One vascular pedicle (eg, tensor fascia lata)
  • Dominant pedicle(s) and minor pedicle(s) (eg, gracilis)
  • Two dominant pedicles (eg, gluteus maximus)
  • Segmental vascular pedicles (eg, sartorius)
  • One dominant pedicle and secondary segmental pedicles (eg, latissimus dorsi)

A Severe Headache in a Young Woman

An ambulance brings a 39-year-old woman complaining of a severe occipital headache and vomiting from her workplace to the emergency department (ED).

Graft classification

Skin grafts can be

• Split-thickness - epidermis and variable amounts of dermis. Commonly taken from the thigh or buttocks. The donor site heals by re-epitheliasation from the dermis and surrounding skin and requires dressings.
• Full - thickness- epidermis and all the dermis. The donor site is either sutured directly or split-thickness skin grafted.
• Composite graft - small grafts containing skin and underlying cartilage or other tissue. Donor sites include, for example, ear skin and cartilage to reconstruct nasal alar rim defects.

wound classification

Clean: An uninfected operative wound in which no inflammation is encountered and the respiratory, alimentary, genital, or uninfected urinary tract is not entered.

Clean-Contaminated: An operative wound in which the respiratory, alimentary, genital, or urinary tracts are entered under controlled conditions and without unusual contamination.

Contaminated: Open, fresh, accidental wounds

Type of Fracture