A comprehensive ontology of flaps in reconstructive surgery

Introduction: The diversity of flap types in plastic surgery has led to multiple classification systems based on factors such as blood supply, tissue composition and distance between donor and recipient site. However, no comprehensive framework exists that systematically integrates all relevant aspects. Capturing the full range of surgical flaps in a structured manner could facilitate future research, improve interoperability, and even optimize billing processes. Ontologies could address this gap. They offer a structured approach to organizing and formalizing knowledge by defining a hierarchical tree of classes and individuals linked logically to other entities. Materials and Methods: We applied principles of ontology engineering, integrating knowledge from surgical literature and clinical expertise to model a wide variety of flaps. These are linked to the Foundational Model of Anatomy (FMA) ontology to describe their tissue components. The reasoner Hermit was employed to ensure logical consistency. Results: Structured hierarchically, the ontology links flaps to relevant anatomical structures and applies logical constraints to define necessary and sufficient conditions for each flap type. This enables precise representation of flap variations, each uniquely identified by an Ontology of Flaps in Reconstructive Surgery Identifier (OFLID). The developed ontology encompasses a wide range of local, pedicled, and free flaps. Simple local random-pattern V-Y flaps to complex chimeric and supercharged free flaps can be modelled and automatically classified. Conclusions: This ontology of surgical flaps could facilitate interoperability, multicentric research and artificial intelligence applications. Future work will focus on validation with larger datasets and expanding the ontology’s functionality.引言：整形外科领域的皮瓣类型繁多，学界已基于血供、组织构成以及供区与受区间距等因素建立了多种分类体系，但目前尚无能够系统整合所有相关维度的综合框架。以结构化方式全面覆盖各类手术皮瓣，将有助于推动后续研究、提升互操作性，甚至优化计费流程。本体（Ontologies）可填补这一空白：其通过定义类与个体的层级树结构，并建立实体间的逻辑关联，为知识的组织与形式化提供了标准化路径。 材料与方法：本研究采用本体工程（Ontology Engineering）原理，整合外科文献与临床经验知识，对多种皮瓣进行建模。本建模关联了解剖学基础模型（Foundational Model of Anatomy, FMA）本体，以描述皮瓣的组织构成；并使用推理机赫米特（Hermit）以确保逻辑一致性。 结果：本本体以层级结构组织，将皮瓣与相关解剖结构关联，并通过逻辑约束为每类皮瓣定义必要且充分的判定条件。这可实现皮瓣变异的精准表征，每类变异均通过重建外科皮瓣本体标识符（Ontology of Flaps in Reconstructive Surgery Identifier, OFLID）进行唯一标识。本研究所构建的本体覆盖了局部皮瓣、带蒂皮瓣与游离皮瓣等多种类型，从简单的局部随机型V-Y皮瓣到复杂的嵌合皮瓣与增压游离皮瓣，均可实现建模与自动分类。 结论：本手术皮瓣本体可提升互操作性、推动多中心研究及人工智能（Artificial Intelligence, AI）应用。未来研究将聚焦于使用更大规模数据集进行验证，并拓展本本体的功能。