> ## Content Index
> Fetch the complete content index at: https://www.theplasticsfella.com/llms.txt
> Use this file to discover other available public pages before exploring further.

# We’re Growing, 3 Flap Classifications, & Sub-I Inequity
- URL: https://www.theplasticsfella.com/april-6th/
- Published: 2025-04-04T17:00:46.000Z
- Updated: 2025-04-11T15:14:42.000Z
- Description: Also: The Sunday quiz, event calendar, & a video tutorial on fat grafting.
- Author: PlasticsFella
- Tags: thePlasticsPaper

#### In this week's edition

1. ****✍️** [****Letter from P'Fella**](https://www.theplasticsfella.com/april-6th/#a-letter-from-pfella)  
Trust us, we’re growing.
2. ****🤓** [****The Sunday Quiz**](https://www.theplasticsfella.com/april-6th/#the-sunday-quiz)  
How well do you know f**asciocutaneous flaps*?
3. 🖼️ [****Image of the Week**](https://www.theplasticsfella.com/april-6th/#image-of-the-week)  
Mathes and Nahai muscle flap classification.
4. ****🚑** [****Technique Tip**](https://www.theplasticsfella.com/april-6th/#technique-tip)  
Keystone design perforator island flap.
5. ****🎈** [****Upcoming Events**](https://www.theplasticsfella.com/april-6th/#upcoming-events)  
Your events deserve a spot here too!
6. 🎓 [****The Fellow's Corner**](https://www.theplasticsfella.com/april-6th/#the-fellows-corner)  
Visual guide to fat grafting.
7. 📖 [****JPRAS Journal Club**](https://www.theplasticsfella.com/april-6th/#jpras-journal-club)  
Sub-internship cost: The numbers speak for themselves
8. ****🔥** [****Articles of the Week**](https://www.theplasticsfella.com/april-6th/#articles-of-the-week)  
Original Mathes and Nahai, Cormack & Lamberty foundational system for fasciocutaneous flaps, & original angiosomes publication: with 1-sentence summaries.
9. 💕 [****Feedback**](https://www.theplasticsfella.com/april-6th/#feedback)  
Suggest ideas & give feedback!

## A Letter from P'Fella

**Trust Us, We’re Growing*

👋

****Hey Team!**  
  
We came in second. Just saw the results from this week’s PlasticsPaper poll — rank your most trusted sources for plastic surgery. And to be totally honest? I was surprised.

Because four years ago, this platform didn’t really exist. There was no reason to trust us. No reason to even notice us.

![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/04/White-and-Green-Minimalist-Table-Comparison-Chart--1-.png)

Your Most Trusted Source

**We Didn’t Set Out to Be Trusted — We Just Wanted Less Noise**

Let’s be real. Most plastic surgery education feels like a bad algorithm: Paywalls, recycled abstracts, and PDFs so dense they make you feel dumber.

That’s why we started this — to cut through the noise.

It wasn’t about being “the best.” It was about being **useful**.

Something you could read between cases. Listen to on the commute. Share with your team.

And slowly, it turns out… that builds trust. Not because we asked for it — but because we showed up. Every week. No clickbait. No sponsorships. No fluff.

**So What Now?**

This poll isn’t a victory lap. It’s a mirror. If people trust us, it means we’ve got a responsibility to **keep earning it**. And if we're not at the top? That’s fair too. There’s still room to grow — and a lot of ground left to cover.

That’s why over the next 12 months, *The Plastics Fella* will be investing **over $100,000** into plastic surgery education.

We’re here for the long game. But first — I want to hear from you.

No trophies. Just trust.   
P’Fella ❤️

## The Sunday Quiz

**How Well Do You Know Fasciocutaneous Flaps?*

****Are you ready to make it to the leaderboard?**  
  
Welcome to the ****next round** of The Weekly Quiz.  
  
Each edition of thePlasticsPaper includes a quiz question designed to challenge and engage our readers. Keep your wits about you and join in every week — the winner at the end of six rounds will earn you a one-year subscription to thePlasticsPro.  
  
❗You asked, we listened: The quiz now runs on a fixed time limit, not a countdown.

---

## Image of the Week

**Mathes and Nahai Muscle Flap Classification*

🖼️

****Image of the Week**   
  
In this section, we feature an anatomical illustration. This week’s image illustrates the ****five types of muscle vascular supply**, as described in the original 1981 classification by ****Mathes and Nahai**.  
  
A foundational concept in flap planning, this system categorises muscles based on the ****number & dominance of vascular pedicles**, which is critical when selecting flaps for reconstruction.

![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/04/image.png)

Mathes and Nahai Muscle Flap Classification

## Technique Tip

**Keystone Design Perforator Island Flap*

🚑

****Technique Tip of the Week**   
  
This week’s tip highlights the original ****Keystone Design Perforator Island Flap**. The flap is trapezoidal, based on perforators, and positioned adjacent to an elliptical defect. The key features include,   
  
\- A 1:1 flap-to-defect width ratio  
\- 90° angled lateral borders  
\- V–Y advancement at each end for tension redistribution  
  
This simple yet effective design allows great coverage without the need for grafts in most cases.

![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/04/Screenshot-2025-04-03-at-13-56-23.png)

[Source](https://pubmed.ncbi.nlm.nih.gov/12608972/?ref=theplasticsfella.com)

## Upcoming Events

**Your Events Deserve a Spot Here Too!*

📅

****P’Fella’s event calendar** highlights the most impactful conferences, high-yield webinars, and carefully curated courses for you.  
  
Got something worth sharing? ****Submit your event and get it featured on our events page!**

## the Fellows' Corner

**Visual Guide to Fat grafting*

📹

This week in the Fellows’ Corner, we’re featuring ****a visual breakdown of fat grafting** by our educational fellow, Benedetta Agnelli.  
  
The video walks through the key steps in ****harvesting**, ****processing**, and ****injecting** ****fat** for optimal graft survival. Watch below for a quick reference for anyone in theatre ▶️

0:00 

/1:33 

1× 

Fat Grafting - Video Guide

## JPRAS Journal Club

**Sub-Internship Cost in the US: The Numbers Speak for Themselves*

🩹

**In Case You Missed It:* **How Much Does a Sub-Internship Actually Cost?**  
  
P’Fella’s educational fellow, Hatan Mortada breaks down a powerful JPRAS study that exposes the stark financial disparities in plastic surgery sub-internships.  
  
 The Numbers Speak:  
\- IMGs face ****17x higher costs** than US peers.  
\- Median cost for \~4.5 away rotations: ****$9,114 for IMGs** vs ****$410 for US students.**   
\- IMGs also have ****80% fewer programs** available to them.

![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/04/How-much-does-a-sub-internship-actually-cost---Journal-Club--1-.png)

![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/04/How-much-does-a-sub-internship-actually-cost---Journal-Club.png)

![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/04/How-much-does-a-sub-internship-actually-cost---Journal-Club--2-.png)

[Read the Article](https://www.theplasticsfella.com/journal-sub-internships/)

## Articles of the Week

**3 Interesting Articles with One-Sentence Summaries*

✅

****Muscle Vascular Classification and Its Role in Flap Design** ([Mathes & Nahai](https://pubmed.ncbi.nlm.nih.gov/7465666/?ref=theplasticsfella.com), 1981)  
  
Mathes and Nahai propose a five-type classification of muscle blood supply, linking vascular anatomy with surgical flap design.

✅

****A Vascular Classification System for Fasciocutaneous Flaps** ([Cormack & Lamberty](https://pubmed.ncbi.nlm.nih.gov/6692066/?ref=theplasticsfella.com), 1984)  
  
This study defines four distinct vascular patterns in fasciocutaneous flaps, laying the anatomical and conceptual foundation for designing reliable and versatile flaps in reconstructive surgery.

✅

****Original Angiosomes Publication: Vascular Guidelines for Flap Design** ([Taylor & Palmer](https://pubmed.ncbi.nlm.nih.gov/3567445/?ref=theplasticsfella.com), 1987)  
  
This foundational work introduces angiosomes through cadaveric dissection and radiographic analysis, defining the 3D vascular territories of source arteries and setting the stage for flap planning.

## Feedback

### I hope you enjoyed it 😄

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