Understanding a skin flap
A local flap moves nearby skin and underlying tissue to cover a wound while preserving its blood supply. It may be recommended when a wound cannot be closed directly or when nearby tissue gives a suitable match in colour, texture and function.
The surgeon plans the flap around the wound, the available skin and nearby features such as the nose, lips or eyelids. The scars extend beyond the original wound because surrounding tissue also needs to be moved and closed.
Different flap techniques
- Advancement: nearby skin moves forward into the wound.
- Rotation: a curved section of skin turns into the wound.
- Transposition: tissue moves across adjacent skin to cover the defect.
- Island: tissue moves on a preserved stalk of blood supply.
- Free flap: tissue from elsewhere is transferred and its vessels reconnected using microsurgery. This is a more complex hospital procedure.
Most local skin cancer reconstructions use a local flap. Your surgeon will explain your specific technique and alternatives, which may include a graft or BTM.
Preparing for your procedure
Bring a current list of medicines, vitamins and supplements, and tell us about allergies to medicines, latex, antiseptics or dressings. Let the team know about diabetes, circulation problems, previous healing difficulties or a tendency to develop thick scars.
Do not stop blood thinners or change prescribed medicines without advice from your treating team. This includes prescribed aspirin. Ask about any medicine instructions before your appointment.
For a procedure under local anaesthetic alone, fasting is usually not needed unless you have been told otherwise. If sedation or general anaesthetic is planned, follow the fasting and medicine instructions provided by your hospital or anaesthetic team. Call if these are unclear.
- Bring your Medicare card, relevant referral or test results, and comfortable clothing that gives access to the treatment area.
- Discuss transport home. Arrange a responsible adult after sedation or general anaesthetic. Wound location, pain and movement can affect driving even after local anaesthetic.
- Smoking can slow healing. Ask your GP or the clinic for help stopping before surgery and during recovery.
- Ask about the benefits, risks, alternatives and likely scar before giving consent. You can ask for more time or further explanation.
During the operation
The cancer is removed with the planned margin. Your surgeon moves the selected tissue into the wound while protecting its blood supply, then closes the flap and surrounding skin with stitches. The removed lesion is sent for pathology.
Dressings and ointments depend on the location and type of closure. Confirm your first wound review and suture-removal appointment before leaving.
Caring for the flap
Keep the dressing in place and the wound dry for the time your surgeon advises. When washing is allowed, clean gently, pat dry and use only the prescribed or recommended products. Avoid soaking or swimming until cleared.
Avoid pressure, rubbing or stretching across the flap. Rest and elevation may help swelling; ask how to position the area during sleep. Do not start massage or place a tight bandage over it without advice.
Contact the clinic urgently if the flap becomes unusually pale, dusky, blue, grey or black, or develops rapidly increasing swelling or pain. A change in blood supply needs prompt assessment. If the clinic is closed, seek urgent medical care.
Recovery and possible problems
Early swelling and bruising should settle gradually. Surface stitches are often removed at about one week on the face and about two weeks on the body or limbs, but the planned date for your flap takes priority.
Possible complications include reduced blood supply causing partial or complete tissue loss, blood collection, infection, wound opening, delayed healing, altered sensation, scarring or changes to nearby features. Further treatment may be needed.
All skin surgery leaves a scar. The early pink, firm or raised appearance can change over many months; scars may continue to mature for 12–18 months. Wound location, skin type, healing and the procedure all affect the final result.
Only start scar massage or silicone products once the wound is fully closed and your clinician says it is ready. Protect healed skin from the sun and let us know if a scar becomes increasingly raised, tight or uncomfortable.
Read about scars and ongoing skin checks →
A clinician will call you if your results require urgent action. Otherwise, your results will be discussed with you at your follow-up appointment.
Confirm your review appointment before leaving. If it has not been arranged, or your results are taking longer than expected, call the clinic. No contact does not mean a result is clear.
When to seek help
- Increasing or spreading redness, warmth or swelling.
- Pain that is getting worse rather than settling, pus, a new unpleasant smell, fever or feeling unwell.
- A wound that opens, a rapidly growing swelling, or a dressing that is repeatedly soaked.
- An unexpected change in the colour or appearance of a graft, flap or BTM wound.
Call 07 7520 8580 promptly. If the clinic is closed and the problem is urgent, seek an urgent medical assessment. Do not wait for a routine review.
For bleeding, apply firm, continuous pressure with a clean dressing. If bleeding persists despite pressure, seek urgent care. For severe bleeding, collapse or another medical emergency, call 000.