How Flap Techniques Are Used in Reconstructive Plastic Surgery

A flap is a piece of tissue still attached to the body by a major artery and vein or at its base. This piece of tissue with its attached blood supply is used in reconstructive surgery by being set into a recipient site (injured area onto which a flap or graft is placed).

Sometimes, the flap consists of skin and fatty tissue only, but a flap may also include muscle from the donor site (the area from which the flap is raised).

This article will review why a flap procedure may be used, as well as the different types of flaps and potential complications from the surgery.

Purpose

If you have suffered tissue loss over any area of your body, you may be a candidate for flap surgery. This type of reconstructive plastic surgery is commonly used to repair defects left behind after traumatic injury or following surgical removal of cancer.

These can include:

• Flap surgery for breast reconstruction following mastectomy
• Repair following surgery for head and neck cancers
• Filling in tissue following a complex skin cancer surgery

Types of Flap Procedures

Flaps come from many different locations and are used in many different ways to accomplish the desired result. However, flaps used for reconstructive plastic surgery can be broken down into two main categories.

Pedicle Flap

Tissue is freed and rotated or moved in some manner from an adjacent area to cover the defect, yet remains attached to the body at its base and has blood vessels that enter into the flap from the donor site.

The type of flap movement required determines which of the four main types of local flaps is used.

• Advancement flap: The flap moves directly forward with no lateral movement.
• Rotation flap: The flap rotates around a pivot point to be positioned into an adjacent defect.
• Transposition flap: The flap moves laterally in relation to a pivot point to be positioned into an adjacent defect.
• Interpolation flap: rotates around a pivot point to be positioned into a nearby (but not adjacent) defect. The result is that a portion of the flap passes above or below a section of intact tissue, forming a sort of “skin bridge.” This flap is intended to be sectioned (separated) from the donor site in a subsequent procedure.

Free Flap

Tissue from another area of the body is detached and transplanted to the recipient site, and the blood supply is surgically reconnected to blood vessels adjacent to the wound.

Potential Complications

Complications possible from flap surgery include general surgical risks such as:

• Infection
• Unfavorable scarring and/or skin discoloration
• Excessive bleeding or hematoma (pooled blood outside a blood vessel)
• Skin or fat necrosis (tissue death)
• Poor wound healing or wound separation
• Blood clots
• Anesthesia risks
• Deep vein thrombosis
• Cardiac and pulmonary complications
• Persistent edema (swelling) or fluid accumulation
• Persistent pain

Flap-specific complications can include:

• Tissue rejection
• Temporary or permanent change/loss of skin sensation
• Unsatisfactory aesthetic results requiring revisional surgery
• Breakage or leaking of the expander

Call your surgeon immediately if you have chest pain, shortness of breath, unusual heartbeat, or excessive bleeding.

Summary

Flap reconstructive plastic surgery is a way to fill in tissue and repair areas of the body that have been significantly affected by trauma or major surgical operations, such as cancer removal.

Multiple types of flap procedures can be done, with each having certain benefits for the area of the body where the surgery will be performed.

The surgery is not without risks, however. These risks should be discussed with the plastic surgeon before having the procedure.

A Word From Verywell

Living through a traumatic experience or having a major surgery that leaves you with a physical defect can be emotionally difficult. Flap surgery may improve the way you feel about yourself. It's important to research plastic surgeons well, and find one that specializes in the type of surgery you need.