> ## 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. # Mathes and Nahai Classification - URL: https://www.theplasticsfella.com/mathes-and-nahai-classification/ - Published: 2024-07-28T16:15:00.000Z - Updated: 2024-07-29T20:19:16.000Z - Description: The Mathes and Nahai Classification, introduced in 1981, describes the vascular supply to muscle and musculocutaneous flaps based on major and minor pedicles. This system is essential for planning reconstructive surgeries to ensure optimal flap survival and function. - Author: PlasticsFella - Tags: Microsurgery, Core Principles #### Summary Card [****Origin and Publication**](https://www.theplasticsfella.com/mathes-and-nahai-classification/#origin-of-mathes-and-nahai-classification) The Mathes and Nahai Classification was introduced as a way of describing the blood supply to muscle and musculocutaneous flaps. [****Mathes and Nahai Classification**](https://www.theplasticsfella.com/mathes-and-nahai-classification/#mathes-and-nahai-classification) Mathes and Nahai classification describes the number of major & minor pedicles of a muscle flap. --- ## Origin of Mathes and Nahai Classification ****Key Point** The Mathes and Nahai Classification was introduced as a way of describing the blood supply to muscle and musculocutaneous flaps. The Mathes and Nahai Classification system was first described in 1981 as a way of describing the blood supply to muscle and musculocutaneous flaps. It was first described by Mathes and Nahai in a 1981 [PRS publication](https://www.ncbi.nlm.nih.gov/pubmed/7465666?ref=theplasticsfella.com). This classification is illustrated in the image below. ![Mathes and Nahai Muscle Flap Classification](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2022/06/mathes-and-nahai-classification.png) Mathes and Nahai Muscle Flap Classification There are some important points for context: - There is no commonly used alternative classification for muscle flaps. - It does not relate to local flaps, such as [rotation](https://www.theplasticsfella.com/rotation-flap/) or [rhomboid](https://www.theplasticsfella.com/rhomboid-flap/) flaps, only muscle. - It is different from Mathe and Nahai's [fasciocutaneous](https://www.theplasticsfella.com/fasciocutaneous-flaps/) flap classification. - Blood supply to muscles and musculocutaneous flaps can be read [here](https://www.theplasticsfella.com/classification-of-flaps/). ![Mathes and Nahai published their original publication for muscle flaps in 1981 in PRS Journal](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2022/06/Mathes-and-Nahai-Classification-Original-Publication.png) Mathes and Nahai 1981 Publication --- ## Mathes and Nahai Classification ****Key Point** Mathes and Nahai classification describes the number of major & minor pedicles of a muscle flap. The Mathes and Nahai classification for muscle flaps can be visualised in the image below. ![The Mathes and Nahai Muscle Flap Classification can be visualised base on the number of major and minor pedicles](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2022/06/3.png) Mathes and Nahai Muscle Flap Classification Key points on the Mathes and Nahai classification system are: - **Type 1:** 1 major pedicle (gastrocnemius) - **Type 2:** 1 major and 1 minor pedicle ([gracilis flap](https://www.theplasticsfella.com/gracilis-flap/)) - **Type 3:** 2 major pedicles ([rectus abdominis](https://www.theplasticsfella.com/vram-flap/)) - **Type 4:** Minor segmental pedicles (sartorius) - **Type 5:** 1 major and minor segmental pedicles (latissimus dorsi flap) These types are illustrated in the diagram below. ![The number of major and minor pedicles for each muscle is used in the Mathes and Nahai Muscle Flap Classification](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2022/06/4.png) Mathes and Nahai Muscle Flap Classification ⚡ ****Tip:** Type I, III, and V muscle flaps have the most reliable blood supply. A mnemonic for Mathes and Nahai Classification is as follows: **Ten Graceful Glutes Sat on Latrines.** - **Type I:** TFL flap - **Type II:** [Gracilis flap](https://www.theplasticsfella.com/gracilis-flap/) - **Type III:** Gluteus maximus flap, [VRAM flap](https://www.theplasticsfella.com/vram-flap/) - **Type IV:** Sartorius flap - **Type V:** Lattisimus dorsi flap Another mnemonic for Muscles flaps is: "Get Good Remembering Supply Lines" · - **Type 1:** Gastrocnemius - **Type 2:** Gracilis - **Type 3:** Rectus abdominis - **Type 4:** Sartorius - **Type 5:** Latissumus dorsi ⚡ Tip: Muscle flaps are more bacterial-resistant than [fasciocutaneous flaps](www.theplasticsfella.com/fasciocutaneous-flaps/). --- ## Conclusion Upon completing this article, you will have accomplished the following: ****1\. Mathes and Nahai Classification:** Gained a detailed understanding of the Mathes and Nahai classification system which describes the vascular supply to muscle and musculocutaneous flaps based on the number and type of vascular pedicles. ****2\. Classification:** Learned the specific types of vascular pedicles that categorize muscle flaps into five different types, enhancing your ability to plan reconstructive surgeries with appropriate flaps. ****3\. Application in Clinical Practice:** Appreciated the relevance of this classification in clinical practice, particularly in reconstructive surgery, to ensure optimal flap survival and functional outcomes. ****4\. Differentiation of Flap Types:** Distinguished between different types of muscle flaps based on their vascular anatomy, which is critical for surgical planning and execution. --- ## References 1. [Classification of the vascular anatomy of muscles: experimental and clinical correlation.](https://www.ncbi.nlm.nih.gov/pubmed/7465666?ref=theplasticsfella.com)[ ](https://www.ncbi.nlm.nih.gov/pubmed/7465666?ref=theplasticsfella.com)Mathes SJ, Nahai F. Plast Reconstr Surg. 1981 Feb;67(2):177-87. 2. [A Practical Guide to Free Tissue Transfer](https://journals.lww.com/plasreconsurg/Abstract/2013/07000/A%5FPractical%5FGuide%5Fto%5FFree%5FTissue%5FTransfer.43.aspx?ref=theplasticsfella.com)[.](https://journals.lww.com/plasreconsurg/Abstract/2013/07000/A%5FPractical%5FGuide%5Fto%5FFree%5FTissue%5FTransfer.43.aspx?ref=theplasticsfella.com) Roehl, Kendall R. M.D et al. Plastic and Reconstructive Surgery: July 2013 – Volume 132 – Issue 1 – p 147e–158e doi: 10.1097/PRS.0b013e3182910fba 3. [The Concepts of Propeller, Perforator, Keystone, and Other Local Flaps and Their Role in the Evolution of Reconstruction](https://www.ncbi.nlm.nih.gov/pubmed/27673542?ref=theplasticsfella.com)[.](https://www.ncbi.nlm.nih.gov/pubmed/27673542?ref=theplasticsfella.com) Mohan, Anita T et al. Plastic and Reconstructive Surgery: October 2016 – Volume 138 – Issue 4 – p 710e-729edoi: 10.1097/PRS.0000000000002610 4. [Advances in muscle and musculocutaneous flaps](https://www.ncbi.nlm.nih.gov/pubmed/6988141?ref=theplasticsfella.com). Mathes SJ, Alpert BS. Clin Plast Surg. 1980 Jan;7(1):15-26.