Local flap reconstruction

Picture of skin surgeon

Local flap reconstruction

A local flap can be a complex but very effective way to reconstruct a skin wound

What is a local skin flap?

Skin surgery can sometimes leave a wound that is not suitable for direct closure. This might be because it is too large to close, and there is not enough loose skin in the area. Alternatively the wound might just be able to be closed but would be very tight, or could distort other features (eg eyebrow or lip) if closed directly. In this case, a local flap might be used.

In surgery, a skin flap is a term used to describe a piece of skin that is lifted and moved from one place to another. Crucially, part of the skin remains attached to where it came from, keeping blood flowing in and out of the skin to keep it alive. Keeping a source of blood flow in and out of the skin is what makes it ‘a flap’. When the skin is moved to a part of the body directly next to it (eg a piece of cheek skin is turned to fill a cheek wound), this is termed a ‘local’ flap. Some fat and/or muscle is often taken with the skin, to help fill the wound and improve the blood flow in the flap.

What types of local flap are there?

There are a number of different types of local flap, and can be described in various ways including the way the flap moves and its shape. Common flap terminology includes advancement, rotation, transposition, rhomboid, ‘V to Y flap’, and ‘H flap’, to name a few. The choice of flap for your skin wound will often depend on factors such as location and size of wound, looseness of skin in the area, and surgeon experience.

How is a local flap stitched in place?

Similar to direct closure of a skin wound, a flap is often held in place by a few deep dissolving stitches. The skin stitches are usually non-dissolving, but may occasionally be dissolving stitches.

What does a local flap scar look like?

Again, this very much depends on the type of flap being used. A rotation flap may be a long curved scar, while a rhomboid flap leaves a scar that looks a bit like a question mark (or one in reverse). Sometimes, the surgeon may make other cuts or change the shape of the flap slightly so as to leave less noticeable scars.
The flap itself may also swell up to start with. This usually improves in time and goes down within a few months.

What happens after local flap surgery?

You will usually be given instructions on how to look after your wound, and if non-dissolving stitches have been used, then these will usually be taken out after 5-7 days. 

The local flap will often look its worst in the first couple of weeks, then it begins to settle over the next 2-3 months. The final result can take up to a year to show.

What are the risks of local flap surgery?

In common with most operations, there are risks of bleeding afterwards (usually stopped by applying gentle pressure), wound infection, and poor scarring. There may also be an area of numbness around the operated area.

There is also, though, a risk of the local flap failing. Local flaps depend on their blood supply to stay alive, and if this is compromised for any reason, the flap can die. The skin and tissue of the flap will die away, and further surgery may be needed; fortunately this is fairly uncommon.

This information is for general information only. If you have any concerns about your health or are considering any skin treatments, you should seek advice from a healthcare skin specialist

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