Patient education: Flap surgery (The Basics)

What is flap surgery? — Flap surgery involves moving a piece of skin and other tissue from 1 part of the body to another. The piece that is moved is called a "flap." During surgery, the flap is cut out along with its blood vessels, then placed in its new location.

Flap surgery is a type of "reconstructive" surgery. Reconstruction involves rebuilding a body part. The goal is to improve appearance, improve function, or both.

Flap surgery can be done in different situations, including:

●To improve appearance after another procedure – When unhealthy tissue is removed with surgery, it can leave a hole, dent, or other change in appearance. Flap surgery can help make the body part look closer to the way it used to. Examples include:

•Repair after removing infected tissue or a tumor

•Repair after a severe burn

•Rebuilding a breast after surgery to treat or prevent cancer ("mastectomy")

●After a serious injury – If an injury caused major damage to a body part, flap surgery can help make it function better or fix its shape and appearance.

●To treat a problem a person was born with – If a body part did not grow or form correctly, flap surgery can sometimes be used to improve function or appearance.

Are there different types of flaps? — Yes. Flaps can be small or large. They can be made from any tissue in the body. The tissue can include skin, muscle, nerves, fat, or bone. A flap can have some or all of these tissues in it, depending on what it is being used for.

Doctors use different terms for flaps based on where they come from and how they are attached. Flaps can come from almost anywhere in the body. A flap might be next to, nearby, or a distance from the area that needs fixing. The blood supply to the flap is important because it keeps the flap alive. The way the blood supply is handled is described as:

●"Pedicled" – This means the flap stays connected to the blood vessels in its original location. A surgeon cuts some tissue out to make a flap, but leaves it partly attached to the body. Then, 1 end of it is moved and reconnected under the skin to a nearby area (figure 1).

●"Free" – This means the flap is completely disconnected from its original location. Its blood vessels are then reattached to vessels in the new part of the body (figure 2).

What type of flap will I get? — Your surgeon will talk to you about your options. The best type of flap will depend on where your injury or problem is, how big it is, and the goals of surgery. When possible, the surgeon will often try to use a flap from a nearby area. Sometimes, a flap from a different area is needed, for example, if bone is being replaced. Another example is when the surgeon needs to work in the same area again ("re-do surgery").

What happens during flap surgery? — The general steps are:

●You will get anesthesia medicines so you won't feel pain. If a large flap is being used or moved, you will probably get "general anesthesia." This is medicine to put you to sleep for the surgery. In some cases, "regional" anesthesia can be used. This type of anesthesia blocks pain in 1 part of your body, like an arm or leg.

●The surgeon will cut your skin to create the flap. The place where the flap comes from is called the "donor site." Then, they will sew it into place in its new location, also called the "recipient site." They will use special tools to reconnect the blood vessels in the area.

●The surgeon will use stitches to close the wound where the flap was removed. They will cover it with a bandage.

The doctors and nurses will watch you after surgery to make sure the blood is flowing to the flap.

What happens after flap surgery? — Most people will need to stay in the hospital for some time after flap surgery. In the hospital, the surgeon can monitor the appearance of the flap. Once your surgeon is happy with your progress, you will be able to go home.

Your doctor or nurse will give you specific instructions for how to care for the flap site after your surgery. In general, the area will be bandaged in a way that keeps the flap from moving. This will help it to heal properly. It's important to follow all the instructions you were given.

How long it will take to recover depends on the type of flap surgery you had. If the flap came from right next to the area being fixed (called "local" flap surgery), recovery can be relatively quick. For others that require more extensive flap surgery, recovery might take longer. You might need rehabilitation, or "rehab," as part of your recovery. This involves specific exercises, for example, to learn to use a muscle again.

After flap surgery, the part that was repaired will have improved appearance and function. Your surgeon will talk to you about what you can expect it to look and feel like.

What problems can happen? — All surgical procedures come with some risks. Your doctor or nurse will talk to you about your surgery and the possible risks. In general, risks of flap surgery include:

●Infection

●Problems with wound healing

●Flap failure – This is when the flap dies, which can happen if blood stops flowing to it, or because of infection or other problems.

●Donor site problems – These are problems in the area the flap was taken from. They can include infection or wound healing problems, or other problems like a hernia or bulge where tissue was removed.

●Nerve damage

More on this topic

Patient education: Breast reconstruction after mastectomy for cancer (The Basics)
Patient education: Questions to ask if you are having surgery or a procedure (The Basics)