A local skin flap is a method of reconstructing a wound using skin and the tissue just beneath it from an area right next to the defect. Unlike a skin graft, the flap keeps its own blood supply and remains connected to nearby tissue as it is moved into place. This allows for a reliable reconstruction that blends naturally with the surrounding skin.
Local flaps are especially valuable on the face because they use the neighbouring skin, which closely matches the original area in colour, texture, and thickness. They are commonly used on the nose, lips, cheeks, forehead, around the eyes, and on the ears.
Common Types of Local Flaps
There are several types of local flaps, chosen based on the location and shape of the wound. Rotation flaps involve rotating a curved piece of nearby skin into the wound, often used on the cheek or temple.
- Advancement flaps slide skin directly forward into the defect, commonly used around the forehead, eyelids, and lips.
- Transposition flaps move skin from an adjacent area by lifting it over a stretch of healthy tissue, such as in a rhombic or nasolabial flap on the face.
- V-Y flaps advance tissue forward while allowing the donor site to close in a V-shaped incision that becomes a Y as it heals, often used on the nose, upper lip, or around the mouth.
The choice of flap is made based on what provides the most natural movement, best colour match, and safest blood supply for your specific defect. The aim is to keep incision in natural skin creases were possible.
What to Expect
First Few Days
After surgery, the flap and surrounding incisions will be covered with dressings. Swelling and bruising are common, particularly on the face. The flap may initially look swollen, bulky, or slightly discoloured as it settles into its new position. Sleeping with your head elevated, avoiding pressure over the area, and keeping the dressings dry all help with healing. You will usually return for your first review around day five to seven to remove sutures.
Weeks One to Four
During this period, swelling and bruising start to improve. The flap may feel firm or numb, and it may appear fuller or raised compared to the surrounding skin. This early appearance is normal and settles as the tissues soften. Once the wounds are healed, we recommend moisturising, massage, or silicone to help improve the scar lines. Most people resume normal activities within one to two weeks but should avoid strenuous activity until advised.
After Four Weeks
In the longer term, the flap gradually becomes more flexible and more similar in appearance to the surrounding skin. Scar lines fade slowly over several months. Fullness, tightness, or firmness improve steadily as swelling resolves. Sun protection is particularly important to help minimise long-term scar visibility on the face.
Six to Twelve Months
Flap Maturation Flap maturation is the slow, steady process of the flap settling into its final appearance. Over several months, the flap becomes softer, less bulky, and more natural in colour and contour. Any temporary irregularities often smooth out on their own. Complete maturation can take six to twelve months.
Possible Complications
As with any surgery, complications can occur. In the early stages, swelling, bruising, infection, or bleeding under the flap may affect healing. Rarely, part of the flap may not get enough blood flow and heal more slowly. Tightness, numbness, or thickened scar lines may occur but usually improve with time, massage, or simple treatments. Long-term concerns can include noticeable scar lines or small contour changes. Most of these improve naturally, but occasionally a minor revision is considered, for example, thinning or debulking a flap.
