How is a flap different from a skin graft?
A local flap stays connected to its blood supply as it moves into the wound.
A skin graft is detached from another area and must develop a blood supply from the wound beneath it.
Scar, Skin & Wound
Local Flap Wound Reconstruction
Local flap wound reconstruction moves nearby skin and underlying tissue, while preserving its blood supply, to cover a wound or tissue defect.
Will it leave a scar?
Yes. The flap and the area it moves from create scars.
Planning aims to balance reliable coverage, movement, and appearance. Scars may extend beyond the original wound.
Is this an outpatient procedure?
Many smaller reconstructions are outpatient procedures.
Larger wounds, medical concerns, or a need for closer monitoring may require a different setting or an overnight stay.
01 · Overview
Using nearby tissue to close a wound
A local flap uses skin, often with the fat beneath it, from beside a wound. The surgeon designs incisions that allow this tissue to move into the opening while keeping a connection that supplies blood. The nearby donor area is usually closed with stitches. [1]
This approach may help cover defects after skin cancer removal, injury, or removal of damaged tissue. It can be useful when pulling the wound edges together would create too much tension or distort a nearby feature. An infected or poorly supplied wound may need other treatment before reconstruction.
Local flap reconstruction is not the same as scar revision, which primarily changes an existing scar, or a free flap, which transfers tissue from a distant site using microsurgery. A local flap may improve coverage and contour, but it replaces a wound with a reconstructed area and new scars.
- Tissue source
- Healthy tissue next to the wound
- Main purpose
- Cover a defect while protecting function
- Anesthesia
- Local anesthesia, sometimes with sedation, or general anesthesia
- Recovery
- Depends on wound size, location, and tissue health
Why use nearby tissue?
Nearby skin may offer a closer match in color, thickness, and texture than tissue from elsewhere. Its existing blood supply can also make it useful for defects that are not suitable for a skin graft. These advantages depend on the condition and flexibility of the surrounding tissue.
Does the wound need to be ready first?
Yes. Your surgeon assesses blood flow, infection, damaged tissue, and the cause of the wound. Some wounds need cleaning, removal of unhealthy tissue, or treatment of an underlying condition before a flap is appropriate. After cancer removal, the timing also depends on confirmation that the cancer has been adequately removed.
02 · Concerns & Goals
What brings people to a consultation
A wound may need more than stitches alone. Your surgeon considers what needs coverage, how the area moves, and what healthy tissue is available nearby.
A wound that cannot close easily
Missing tissue or tight surrounding skin can make simple stitching unreliable or place too much pull on the wound.
Exposed or vulnerable structures
Some wounds need healthy tissue over structures such as tendons, bone, or cartilage. The coverage needed depends on the depth and location.
Pulling near a facial feature or joint
A closure near an eyelid, nose, lip, or joint needs careful planning to limit distortion or restricted movement.
A noticeable defect or uneven contour
You may want to discuss how coverage could affect the area's shape, texture, and scars, while keeping wound healing the priority.
03 · Options
How the approaches differ
Local flaps are named partly by how nearby tissue moves. These are planning approaches, not a menu you need to choose alone; a surgeon may combine designs or recommend another type of closure.
Advancement flap
Nearby tissue slides forward into the defect.
How it worksIncisions release tissue so it can advance while retaining its blood supply.
May suitSelected defects with enough flexible skin along one or more edges.
Main tradeoffMovement is limited by local skin looseness, and tension may affect adjacent structures.
Rotation flap
A curved segment of tissue turns into the wound.
How it worksA curved incision allows neighboring tissue to rotate around a base.
May suitSelected defects where tension needs to be spread over a broader area.
Main tradeoffThe curved scar may be substantially longer than the original wound.
Transposition flap
Nearby tissue moves across adjacent skin into the defect.
How it worksThe flap pivots into place, redirecting tension away from the wound.
May suitSelected defects where tissue from a different nearby direction offers better coverage.
Main tradeoffAdditional scar lines and temporary or lasting fullness may occur.
Island advancement flap
A small island of tissue advances on an attached tissue base.
How it worksSkin is released around the flap while an underlying connection maintains blood flow.
May suitSelected smaller defects where local anatomy allows controlled movement.
Main tradeoffTravel is limited, and the flap may heal with a raised contour or altered sensation.
The flap must have a reliable blood supply and reach the wound without excessive tension. Its design depends on the defect and nearby anatomy. [1].
Can reconstruction happen immediately after skin cancer removal?
Sometimes. Reconstruction may follow removal once the treating team is satisfied that the cancer has been adequately cleared. In other cases, closure is delayed while pathology results or further treatment are considered.
Will more than one operation be needed?
Many local flaps are completed in one operation, but some designs or complex wounds need staged treatment. Later scar or contour revision is a separate possibility, not a routine requirement.
04 · Results
What may improve and what may remain
Wound coverage
The main goal is a stable, healed closure.
- Healthy tissue is positioned over the defect to protect the area beneath it.
- Successful healing depends on blood flow, wound condition, tension, and overall health.
- Delayed healing or tissue loss may require additional wound care or surgery.
Movement and comfort
Planning considers how the area needs to function.
- A flap may help avoid the tight pulling that direct closure could cause.
- Swelling, tenderness, and stiffness can temporarily affect movement.
- Some locations may need guided rehabilitation or further treatment if tightness persists.
Contour and scars
Appearance changes gradually as the tissue settles.
- Nearby tissue may blend reasonably well, but a perfect match is not assured.
- Scars can remain visible, and the flap may look raised, indented, or uneven.
- Scar softening and fading continue for months; later revision may be discussed after healing.
Reconstruction does not remove the need for ongoing skin cancer follow-up when cancer treatment caused the defect. [3]
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's location, size, and blood supply. Your team should provide a plan for dressings, positioning, activity, and follow-up. Returning to work does not mean the flap is fully healed.
Step 1 · Day of surgery
Treatment day
The wound is prepared, the flap is moved and secured, and a dressing is applied. Before discharge, the team explains how to protect the area and which changes need a call.
Step 2 · First several days
Early protection
Swelling, bruising, tenderness, and temporary numbness can occur. Protecting blood flow and avoiding tension are priorities. Follow the team's specific positioning and dressing instructions.
Step 3 · Often during the first 1–2 weeks
Wound checks
Visits may include checks of flap color, wound closure, and any drainage. Stitch removal depends on location and healing; some stitches dissolve instead.
Step 4 · Following weeks to months
Strengthening and scar settling
Activities increase as the surgeon confirms healing. Swelling and firmness usually change gradually, while scars continue to mature. Scar treatment should begin only when the team says the wound is ready.
Planning everyday activities
ActivityGeneral planning contextWhat affects the plan
Desk workPlanning context: May be possible within days to a couple of weeks for some smaller flaps.What affects it: Location, discomfort, dressings, and the ability to avoid pressure or strain can change this timing.
Exercise and liftingPlanning context: Resume only within the limits set for your flap.What affects it: Straining, repeated movement, or stretching the closure can increase bleeding or wound separation.
Bathing and swimmingPlanning context: Ask when showering is allowed and how to keep the dressing protected.What affects it: Soaking and swimming usually wait until the wound is closed and the team clears them.
DrivingPlanning context: Wait until you can drive safely and are no longer taking impairing medication.What affects it: Restricted vision, limb movement, or painful turning may delay a safe return.
These are discussion points, not a personal recovery schedule. Follow your surgical team's instructions for your wound and flap.
Before your procedure
- Share your medical history, including diabetes, circulation problems, prior radiation, and wound-healing difficulties.
- Review all medicines and supplements; do not stop prescribed blood thinners without an agreed plan.
- Discuss smoking, vaping, and nicotine use, and follow the team's cessation plan.
- Confirm whether wound cleaning, infection treatment, or cancer pathology results are needed before closure.
- Arrange transportation and help at home if sedation, anesthesia, or the flap location will limit your activities.
- Get written instructions for fasting if needed, dressing care, follow-up visits, and after-hours contact.
Should I use compresses for swelling?
Ask your surgical team whether compresses are appropriate and exactly how to use them. A flap has specific blood-flow needs, and pressure or temperature changes may be unsuitable for your reconstruction.
When can I start scar massage or silicone treatment?
Only after the wound has closed adequately and your surgical team approves. Open areas, fragile tissue, and flap location can change what is safe and when to begin.
06 · Safety
Risks and what your clinician assesses
Early swelling, bruising, tenderness, tightness, and altered sensation are common possibilities. Symptoms should generally settle rather than rapidly worsen; changes in flap color, temperature, or pain need prompt advice.
Reduced blood flow or flap loss
Part or all of the moved tissue may not survive. Additional dressings, tissue removal, or another reconstruction may be needed.
Bleeding or a blood collection
Bleeding beneath the flap can cause swelling and pressure that threaten healing and may need treatment.
Infection
Infection may delay healing or damage the reconstruction. Treatment can include antibiotics or another procedure.
Wound separation or delayed healing
Edges may open or heal slowly, particularly where there is tension or poor circulation.
Scarring, distortion, or sensation changes
Raised scars, uneven contour, pulling on nearby features, numbness, or persistent discomfort can occur. Some changes may last.
Anesthesia and other surgical complications
Medication reactions and heart, lung, or blood-clot complications are possible. The level of risk depends on the procedure and your health.
Discuss these risks and your individual health history with your surgeon. [2]
What your clinician assesses
- Wound size, depth, cause, and any infection or exposed structures
- Nearby tissue flexibility, blood supply, scars, and prior radiation
- Diabetes control, nutrition, nicotine use, and other healing risks
- Medicines, anesthesia needs, functional goals, and ability to manage aftercare
07 · Costs
What makes up the Total Procedure & Care Cost
Compare written estimates for the same planned scope: wound preparation, flap reconstruction, anesthesia, facility use, and follow-up. Coverage and out-of-pocket costs depend on your plan and whether the reconstruction meets its medical-necessity requirements.
Surgeon
Surgical care
Surgeon services for wound preparation and flap reconstruction.
Ask your surgeonAsk whether tissue removal, staged surgery, or later revision is included or billed separately.
Facility
Anesthesia and facility
The procedure setting and any anesthesia services.
Ask your surgeonConfirm the planned setting, anesthesia type, and whether separate providers will send bills.
Supplies
Supplies and follow-up
Dressings, prescribed supplies, and postoperative visits.
Ask your surgeonAsk which supplies and visits are included and how unexpected wound-care needs are charged.
TRC
Patient Services
Any separately listed care-coordination or administrative services.
Ask TRCAsk whether these services apply, what they include, and whether they are optional or covered by insurance.
Your written estimate should explain the services included, any separate charges, and payment terms.
08 · Questions
Common questions
Does a local flap mean only local anesthesia?
No. “Local” describes where the tissue comes from, not the anesthesia. Some flaps can be performed with local anesthesia, while others need sedation or general anesthesia.
Can a flap repair a chronic wound?
Sometimes, but the cause of the wound needs attention first. Poor circulation, pressure, infection, or uncontrolled diabetes can prevent a flap from healing. Consultation determines whether reconstruction is appropriate.
Will hair grow on the flap?
If the moved tissue contains hair follicles, hair may continue to grow in its new location. Your surgeon considers this when choosing nearby tissue.
Can I choose the smallest scar?
You can share that preference, but a short scar is not always the safest closure. A longer flap design may reduce tension or better protect a nearby feature. Ask your surgeon to show you the expected incision pattern.
0 consultation questions in your plan
View in My TRC workspaceMy Aesthetic Plan
Prepare for your consultation
Bring these to help your consultation:
- Understand the proposed flap, alternatives, scar pattern, and possible need for further treatment.
- Have a personalized plan for medicines, nicotine cessation, wound care, and activity limits.
- Confirm follow-up appointments, urgent contact details, and a written cost estimate.
View My Aesthetic Plan
Choices stay in this visit until saving to your account completes. Nothing is sent to a clinician.
Sources
- [1]American Society of Plastic Surgeons — Skin Cancer Removal: ProcedureLocal flap reconstruction after skin cancer removal, movement of adjacent tissue with its blood supply, and comparison with skin graft closure.
- [2]American Society of Plastic Surgeons — Skin Cancer Removal: Risks and SafetyReconstructive surgery risks including bleeding, infection, poor healing, sensation changes, flap failure, anesthesia risks, and urgent evaluation for chest pain or shortness of breath.
- [3]American Society of Plastic Surgeons — Skin Cancer Removal: RecoveryIndividualized postoperative wound care, gradual scar improvement, and continued follow-up after skin cancer treatment.
Photographs are illustrative scenes, not patients, staff, facilities or outcomes. This information does not replace a personal assessment by your treating clinician.