From the Research
The Mahes and Nahe flap classification is not a widely recognized system, and the most recent and highest quality study suggests a broadened classification of free-style flaps into three categories: angiosomal, extra-angiosomal, and neoangiosomal flaps 1. This classification is based on the concept of perforasome, which involves the study of the territory and linking of perforator vessels. The angiosomal category includes all traditional perforator flaps and their variations, while the extra-angiosomal category includes flaps that are manufactured to include tissue from a different angiosome. The neoangiosomal category includes flaps based on the process of neoangiogenesis on autologous or allogenous tissue.
Some key points to consider when classifying flaps include:
- The position of the supplying perforator
- The reconstructive necessities and the skin island
- The flap blood supply
- The aesthetic and functional demands of the reconstructed areas Understanding this classification helps surgeons select the most appropriate flap for specific reconstructive needs based on the defect location, size, and tissue requirements, as well as the patient's overall condition and available donor sites 1.
It's worth noting that other studies have discussed different types of flaps, such as random pattern flaps and axial pattern flaps, and their characteristics and applications in reconstructive surgery 2, 3, 4. However, the most recent and highest quality study suggests that the broadened classification of free-style flaps is a more comprehensive and useful system for surgeons 1.
In terms of morbidity, mortality, and quality of life, the choice of flap classification system can have a significant impact on patient outcomes. For example, a study found that sensory recovery after reconstruction was observed with all flap types, and better sensory recovery can be achieved in a shorter time postsurgery using random pattern flaps 2. Therefore, it is recommended to use the broadened classification of free-style flaps to guide flap selection and reconstruction strategies, in order to optimize patient outcomes and minimize morbidity and mortality 1.