Fasciocutaneous Flaps

A fasciocutaneous flap is raised with its skin, fat and fascia. It was first described by Ponten and is commonly classified using the Cormack and Lamberty system.
Fasciocutaneous Flaps


Definition of Fasciocutaneous Flaps

A fasciocutaneous flap includes the skin, subcutaneous fat and the fascia but not the muscle - this is the original definition by Ponten in 1981

Flap classification has evolved. Since this first description our understanding has progressed to include these key concepts:

  • Including deep fascia with its prefascial & subfascial plexus enhances the circulation of these flaps.
  • They can be raised without skin and are then referred to as fascial flaps.
  • They can be raised with fat and no skin, which is called adipofascial flaps.


Classification of Fasciocutaneous Flaps

There are two common methods of fasciocutaneous flap classification: Cormack and Lamberty and Mathes and Nahai (they also have a muscle flap classification).

Cormack and Lamberty Classification

  • Type A: multiple anonymous vessels entering the flap base. For example, the majority of lower limb flaps.
  • Type B: single fasciocutaneous flaps along the axis. For example, a scapular flap.
  • Type C: a collection of perforators arising from a deep artery in the septum between muscles. For example, a radial forearm flap.
  • Type D: osteofasciocutaneous flaps (for example, a radial forearm flap with radius). These are also called "Type C with a bone".

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Mnemonic:

Type A has Anonymous vessels, Type B is a Bachelor (single), Type C is a collection, and Type D is deep!

Mathes and Nahai Classification

  • Type A: direct cutaneous pedicles. For example, a groin flap or a Foucher flap.
  • Type B: septocutaneous pedicle. For example, scapular flap or PIA flap.
  • Type C: musculocutaneous pedicle. For example, ALT flap.

For a broader overview of the types of flaps, check out this article here.


Advantages and Disadvantages of Fasciocutaneous Flaps

Like all aspects of surgery, there are pros and cons to every operation and surgery.

Advantages:

  • Preservation of muscle
  • Thin and pliable
  • Can incorporate sensory nerves

Disadvantages:

  • Donor site morbidity
  • It may require skin grafting
  • Less bulk and less resistance to infection (when compared to muscle flaps)


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