A new concept of vascular supply to the skin and classification of skin flaps according to their vascularization

The success of fasciocutaneous flaps is based on the existence of epifascial vascular networks and reliable blood supply. However, there has been no thorough classification of the vascular anatomy of the fascia and skin and there is some confusion in regard to cutaneous vascular nomenclature. We divide the vascular systems involved in the cutaneous circulation into four categories. This permits classification of skin flaps into five types (cutaneous, fasciocutaneous, adipofascial, septocutaneous, and musculocutaneous flaps). Fasciocutaneous flaps can be further divided into six types, according to the patterns of the vascular input to the fasciocutaneous plexus. This classification has been demonstrated to be related to clinical effects. Nine new free and island flaps are discussed.