Muscle Flaps (Mathes and Nahai Classification)

Mar 14, 2021 2 min read
Muscle Flaps (Mathes and Nahai Classification)

The Mathes and Nahai Classification was first described in 1981. It groups muscles flaps based on the number of pedicles available.

Overview of Muscle Flaps

A classification system for muscle and musculocutaneous flaps, described by Mathes and Nahai in a 1981 PRS publication,

o date, the have been no alternative classification for muscle flaps commonly used in clinical practice. This is classification does not relate to local flaps such as rotation or rhomboid flaps.

A foundation explanation of blood supply to muscles and musculocutaneous flaps can be read here.


Mathes and Nahai Classification

The Mathes and Nahai Classification allocated flaps into 5 groups based on the number of pedicles.

Major PedicleMinor PedicleExampleComment
11Gastrocnemius
TFL
21>1Gracilis
Trapezius
Ligate minor
pedicles
32Pec Minor
Rectus Abdominis
Raise on either
pedicle
4Multiple
Segmental
Sartorius 
Tibialis Anterior
Rarely used
51Multiple 
segmental
Latissimus Dorsi
Pec Major
Raise on either
pedicle

Mathes and Nahai Drawings

Visual illustration of the Mathes and Nahai Classification for muscle flaps.

Visual illustration of the Mathes and Nahai Classification for muscle flaps

Mathes and Nahai Mnemonic

Mnemonic for Mathes and Nahai Classification is as follows: Ten Graceful Glutes Sat on Latrines.

  • Type I: TFL Flap
  • Type II: Gracilis Flap
  • Type III: Gluteus maximus Flap
  • Type IV: Sartorius Flap
  • Type V: Lattisimus dorsi flap

Sources

  1. Classification of the vascular anatomy of muscles: experimental and clinical correlation. Mathes SJ, Nahai F. Plast Reconstr Surg. 1981 Feb;67(2):177-87.
  2. A Practical Guide to Free Tissue Transfer. 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. 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. Mathes SJ, Alpert BS. Clin Plast Surg. 1980 Jan;7(1):15-26.
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