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In the second episode of How I Operate, Ryan Sugrue (ThePlasticsFella) sits down with Professor Foad Nahai, co-creator of the Mathes & Nahai classification, one of the most influential frameworks in reconstructive surgery.

More than four decades after its publication, the classification remains a cornerstone of plastic surgery training and clinical practice. Professor Nahai reflects on the anatomy lab discoveries, clinical challenges, and collaborative work with Dr. Stephen Mathes that led to the development of a system that transformed how surgeons understand muscle flaps. Together, they explore the origins of the classification, its lasting relevance, and the principles that continue to shape reconstructive surgery today.

Key Takeaways:

• How the Mathes & Nahai classification was developed from anatomical research.
• Why understanding vascular anatomy changed the reliability of muscle flaps.
• The role of anatomy in advancing reconstructive and microsurgical techniques.
• Lessons learned from creating a framework that has remained relevant for over 40 years.
• Why simplicity, clinical relevance, and practicality are key to lasting surgical innovation.

Chapters:

00:00 – Introducing the Mathes & Nahai Classification
04:09 – Muscle Flaps Before the Classification
09:04 – Reconstruction, Microsurgery, and a Changing Specialty
13:13 – Why Anatomy Still Matters
17:06 – Discovering the Pattern in the Anatomy Lab
22:40 – Publishing the Research and Early Reception
24:40 – Building a Framework That Lasted
31:16 – Seeing the Classification Adopted Worldwide
34:18 – Clinical Impact Beyond the Classification
38:48 – Advice for the Next Generation of Surgeons

Thank you for listening to How I Operate. Brought to you by ThePlasticsFella.

If you enjoyed this episode, please follow the show, leave a rating, and share it with colleagues. New episodes are released bi-weekly, exploring the ideas, techniques, and innovations that continue to shape modern plastic surgery.