What makes this a local flap?
The repair uses tissue next to the wound that stays connected to its blood supply.
This differs from a skin graft, which is fully detached from another area and must establish a blood supply at the repair site.
Facial reconstruction
Local Flap Facial Reconstruction
Local flap facial reconstruction moves nearby skin and soft tissue, with its blood supply attached, to repair a facial wound.
Is it always done in one operation?
Some local flaps are completed in one operation; others need planned stages.
The wound's location, depth, and size help determine the approach and whether later refinement may be useful.
Will there be a scar?
Yes. Both the wound repair and the incisions needed to move tissue leave scars.
Surgeons plan incisions to balance reliable coverage, facial movement, and scar placement, but scars cannot be eliminated.
01 · Overview
Repairing a wound with nearby tissue
Local flap reconstruction may be considered after skin cancer removal, an injury, or another operation leaves a facial wound. After Mohs surgery, repair may involve stitches, a flap, a skin graft, or allowing the wound to heal on its own. [1]
For a local flap, the surgeon releases and moves nearby tissue into the wound while preserving a connection that supplies blood. The design depends on the available skin and how movement could affect an eyelid, nostril, lip, or other facial feature.
A local flap is not a facelift or a free flap. A facelift repositions tissue primarily to address aging changes. A free flap transfers tissue from a distant area and reconnects blood vessels. A skin graft also transfers detached tissue, but without reconnecting its vessels directly.
- Purpose
- Close a facial wound and support nearby function
- Tissue used
- Adjacent skin and soft tissue with an attached blood supply
- Anesthesia
- Local anesthesia, sometimes with sedation or general anesthesia
- Treatment plan
- One operation or a planned staged repair
Why use nearby tissue?
Nearby tissue may offer a useful match in color, thickness, and texture. It can also provide coverage where simple stitches would create too much tension. The tradeoff is a larger incision pattern and possible changes to adjacent contours.
When is the final plan chosen?
Your surgeon may discuss likely approaches beforehand, but the final design often depends on the wound after damaged tissue or cancer has been removed. If cancer is involved, ask how clearance will be confirmed before reconstruction.
02 · Concerns & Goals
What your reconstruction may need to address
A facial wound can affect appearance, comfort, and everyday movement. Your surgeon will consider both the missing tissue and the structures around it.
An open wound
The repair needs to cover the defect with tissue that has a reliable blood supply.
Movement and comfort
Wounds near the eyelid, nose, or mouth may affect blinking, breathing, eating, or speech. Protecting these functions helps guide the design.
Facial contours
Missing tissue can leave a depression or an uneven edge. Reconstruction aims to restore coverage and shape, though differences may remain.
Visible scars
Incisions may extend beyond the original wound. Ask where scars will lie and how they may change as they mature.
03 · Options
How the approaches differ
These are common ways local tissue can be moved, not interchangeable choices. Your surgeon will recommend a design based on your wound and facial anatomy.
Advancement flap
Slides nearby tissue toward the wound.
How it worksIncisions release adjacent tissue so it can move forward while keeping its blood supply attached.
May suitSelected wounds with enough nearby skin mobility.
Main tradeoffTension can shift nearby landmarks, and additional incisions may be needed.
Rotation flap
Swings adjacent tissue into place along a curved path.
How it worksA curved incision allows a flap to rotate around an attached base.
May suitSelected defects where surrounding tissue can be redirected without excessive pulling.
Main tradeoffThe curved incision may be much longer than the wound itself.
Transposition flap
Moves tissue over an intervening area into the wound.
How it worksAn adjacent flap pivots into the defect; designs may include a bilobed flap.
May suitSelected facial wounds where tissue is more available beside, rather than directly behind, the defect.
Main tradeoffRaised contours, extra scar lines, or distortion can occur.
Island pedicle flap
Moves a skin island supported by an underlying tissue connection.
How it worksThe skin edges are released while a deeper attachment maintains blood flow.
May suitSelected defects needing targeted movement of nearby skin.
Main tradeoffBulk, limited movement, or pulling may affect the final contour.
A flap is one possible method of wound repair. Direct closure, a skin graft, or healing without surgical closure may be appropriate for some wounds. [1] [2].
Is a forehead flap the same procedure?
A forehead flap usually brings tissue from the forehead to the nose through an attached bridge of tissue and commonly requires staged surgery. It is generally described as a regional flap rather than a simple adjacent local flap. Ask your surgeon to name the proposed flap and explain each stage.
Can I choose the smallest scar?
Scar length is only one consideration. A longer incision may allow safer tissue movement with less tension on an eyelid, nostril, or lip. Ask how each feasible approach balances scar placement, blood supply, and function.
04 · Results
What may improve and what may remain
Wound coverage
The main goal is stable coverage of the missing tissue.
- Success depends partly on blood flow, wound condition, and overall health.
- Delayed healing or tissue loss can require additional wound care or surgery.
Function and shape
The plan should account for nearby facial structures.
- The surgeon aims to avoid excessive pulling on eyelids, nostrils, and lips.
- Residual asymmetry, tightness, or contour differences may remain.
Scar maturation
The early appearance is not the settled result.
- Swelling, firmness, and redness usually change over time.
- Scars can continue to soften and fade for many months.
- Some patients discuss later scar or contour revision once healing is established.
Reconstruction repairs the wound; it does not replace follow-up for the condition that caused it. After skin cancer treatment, continue the skin checks your treating team recommends. [1]
05 · Recovery
Planning your recovery
Recovery at a glance
- Stay after surgery
- Determined by Your Surgeon
- Initial recovery at home
- Varies by Individual
- Return to desk work
- Varies by Procedure and Work Activity
- Light daily activities
- Based on Individual Recovery
- Strenuous exercise
- Based on Surgeon Clearance
Returning to work does not mean fully healed. Follow your surgeon’s instructions; strenuous activity requires clearance.
Recovery depends on the flap, its location, and whether treatment is staged. Your surgical team's instructions take priority, and returning to work does not mean the tissue has fully healed.
Step 1 · Day of surgery
Treatment day
The flap is positioned and stitched into place. Before discharge, the team should explain dressing care, medicines, activity limits, and whom to contact with concerns.
Step 2 · First several days
Early monitoring
Swelling, bruising, tenderness, and tightness can occur. Follow-up may focus on the flap's blood supply and wound edges. Ask your surgical team whether compresses are appropriate and exactly how to use them.
Step 3 · Following weeks
Wound healing
Your team checks healing and removes any stitches that need removal. Dressing needs and activity restrictions may change. A staged repair may involve another procedure on its own schedule.
Step 4 · Following months
Settling and review
Scars and contours gradually settle. Persistent tightness, raised areas, or functional concerns can be reviewed, and further treatment considered when appropriate.
Planning everyday activities
ActivityGeneral planning contextWhat affects the plan
Work and social plansPlanning context: Timing depends on wound visibility, dressings, discomfort, and job demands.What affects it: A desk job and a physically demanding job may need different return plans.
Exercise and liftingPlanning context: Ask when walking, bending, lifting, and strenuous exercise can resume. [1]What affects it: Strain can increase bleeding, swelling, or tension on the repair.
Washing and groomingPlanning context: Get instructions for showering, shaving, makeup, and skin products near the wound.What affects it: Rubbing or disturbing dressings can interfere with healing.
Glasses and face coveringsPlanning context: Discuss anything that rests on or rubs the flap.What affects it: Pressure may need to be avoided or redirected during early healing.
Ask for restrictions tailored to the exact repair, including how you will know it is safe to increase activity.
Before your procedure
- Discuss the wound's cause and whether any further removal or testing is expected.
- Share your medical conditions, prior facial surgery, radiation history, and healing problems.
- Review all medicines and supplements; do not stop prescribed medicines without the treating team's advice.
- Discuss smoking, vaping, and nicotine use and the team's plan to support healing.
- Confirm anesthesia, fasting requirements, transportation, and whether someone should stay with you.
- Arrange follow-up and obtain written wound-care instructions and an after-hours contact number.
Will numbness go away?
Sensation may change because small skin nerves are disturbed. It can improve gradually, but some numbness or altered sensation may persist. New weakness or a change in eye closure deserves prompt assessment.
When can scar care begin?
Ask your surgeon when the wound is closed enough for sunscreen, silicone products, massage, or other scar care. Starting products or massage too soon can irritate or disrupt the repair.
06 · Safety
Risks and what your clinician assesses
Some swelling, bruising, tenderness, redness along incisions, and altered sensation can occur early. Symptoms should be reviewed if they worsen rather than gradually improve.
Bleeding or a blood collection
Bleeding beneath the flap can create pressure and may require drainage or another procedure.
Infection
Infection can delay healing and may require medicines or further treatment.
Reduced blood supply
Part or all of the flap can fail to survive, potentially requiring wound care or additional reconstruction.
Wound separation
Incisions can open or heal slowly, particularly when tension or healing problems are present.
Scarring and distortion
Raised scars, bulk, uneven contours, or pulling on nearby structures can affect appearance or function.
Nerve or anesthesia complications
Numbness, persistent pain, or less commonly weakness can occur. Anesthesia has additional risks that depend on the method and your health.
Discuss these risks and your individual health history with your surgeon. [1]
What your clinician assesses
- Wound size, depth, location, and nearby facial structures
- Available tissue, skin mobility, and blood supply
- Diabetes, immune conditions, nicotine use, and other healing factors
- Medicines, bleeding history, and anesthesia needs
07 · Costs
What makes up the Total Procedure & Care Cost
Compare written estimates for the same planned scope, including the flap design, anesthesia setting, planned stages, and follow-up. Coverage and out-of-pocket costs depend on your insurance and treatment plan.
Surgeon
Surgical care
Assessment, flap reconstruction, and any planned additional surgical stages.
Ask your surgeonAsk whether wound preparation, later stages, or revisions are included or billed separately.
Facility
Anesthesia and facility
The treatment setting and any anesthesia services.
Ask your surgeonConfirm separate professional or facility bills and each provider's insurance participation.
Supplies
Supplies and follow-up
Dressings, prescribed medicines, and postoperative visits.
Ask your surgeonAsk which supplies and visits are included and how unexpected wound care is billed.
TRC
Patient Services
Any separately offered care-coordination or administrative support.
Ask TRCAsk whether these services apply, whether they are optional, and whether they carry a separate charge.
Your written estimate should explain the services included, any separate charges, and payment terms.
08 · Questions
Common questions
Can reconstruction happen immediately after Mohs surgery?
It often can, but timing depends on cancer clearance, wound complexity, and coordination between the treating surgeons. Some repairs are scheduled separately.
Will the flap look exactly like the surrounding skin?
Nearby skin may be a useful match, but differences in thickness, texture, color, and contour can remain. Scars are expected.
Does a local flap require general anesthesia?
Not always. Some repairs use local anesthesia alone. Sedation or general anesthesia may be considered for more extensive work or individual needs.
Will insurance cover it?
Reconstruction may be covered when medically necessary, but benefits, authorization rules, networks, and cost sharing vary. Confirm the planned procedure and providers with your insurer.
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- I understand the proposed flap, alternatives, and possible stages.
- I have a personalized recovery plan and follow-up contact information.
- I have reviewed the written estimate and insurance requirements.
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Sources
- [1]Mayo Clinic: Mohs surgeryWound repair options after Mohs surgery, including flaps and grafts; bleeding, infection, nerve symptoms, wound-healing concerns; postoperative activity precautions and ongoing skin cancer follow-up.
- [2]MedlinePlus: Skin graftSkin grafting as transfer of skin from a donor site to cover a wound and as an alternative reconstructive approach.
Photographs are illustrative scenes, not patients, staff, facilities or outcomes. This information does not replace a personal assessment by your treating clinician.