Further Clarification of the Nomenclature for Compound Flaps

Learning Objectives: After studying this article, the participant should be able to: 1. Understand the attributes and unique niche for compound flaps and their limitations. 2. Comprehend a proposed schema for further clarifying the classification of all types of compound flaps that is differentiated on the basis of the distinct vascular supply to each flap subtype. 3. Appreciate that minor technical modifications of known flaps of any type in general do not necessarily create a new category of flap. Background: A unique niche exists for compound flaps because of their extraordinary capability to allow repair of massive defects where the simultaneous restoration of multiple missing tissue components is demanded. The guidelines from the previous "simplified" classification schema need to be updated to allow a more complete clarification and further standardization of this concept. Methods: Compound flaps can be partitioned into two major classes that in turn are further differentiated into various subtypes according to their inherent pattern of circulation. Results: The subdivisions of compound flaps are those with a solitary source of vascularization and those with combinations of sources of vascularization. Those with a solitary source include composite flaps, defined as multiple tissue components all served by the same single vascular supply, and thereby consisting of dependent parts. Those flaps with combinations of sources of vascularization include (1) conjoined flaps, defined as multiple flap territories, dependent because of some common physical junction, yet each retaining its independent vascular supply; and (2) chimeric flaps, defined as multiple flap territories, each with an independent vascular supply, and independent of any physical interconnection except where linked by a common source vessel. Conclusions: Although many technical modifications have improved and will improve the reliability and versatility of compound flaps, these maneuvers alone should not be confused with creating distinct flap types but rather acknowledged to be only important variations. With this understanding, this revised nomenclature system for compound flaps is intended to be a means of standardizing communication and to facilitate research agendas on a common ground, fully realizing its primary role still only to serve as a convenient guideline. (Plast. Reconstr. Surg. 117: 151e, 2006.)