Flap Surgery: reconstruction's core technique
A flap is tissue moved with its own blood supply intact to close a wound too large or too deep for a simple skin graft — ranging from a local flap (nearby tissue rotated into place) to a free flap (tissue transferred from elsewhere and reconnected microsurgically). The choice depends on defect size, location, and what structures need covering.
Flap vs graft: why the distinction matters
A skin graft is tissue transplanted without its own blood supply — it survives by "taking root" from the blood supply of the wound bed beneath it, which means it needs a clean, healthy, well-vascularised base to work, and it cannot survive over exposed bone, tendon, or poorly vascularised tissue. A flap, by contrast, brings its own blood supply along with it — either kept attached and moved from nearby (a local or regional flap) or completely transferred and microsurgically reconnected (a free flap, see microsurgery). This means a flap can reliably cover wounds that would cause a graft to simply fail.
Local, regional, and free flaps — how the choice is made
The choice depends mainly on the defect's size, location, and what deeper structures need covering. A local flap (nearby tissue rotated or advanced into the defect) is the simplest option when suitable tissue is close by. A regional flap uses tissue from a nearby but more distant area, still attached to its original blood supply through a defined path. A free flap is used when no suitable local or regional option exists — the tissue is fully detached, moved to the defect, and its vessels reconnected under the microscope. Surgeons generally choose the simplest option that reliably solves the problem, reserving free flaps for defects that genuinely need them.
What recovery and flap monitoring involve
Because a flap's survival depends entirely on its blood supply working correctly, the first few days after surgery involve close monitoring — checking colour, temperature, and blood flow regularly, often requiring a hospital stay, since a blood supply problem caught early can sometimes be corrected, while one caught late may not be. Beyond this critical early period, recovery and return to normal activity follows a timeline set by the flap's size, location, and the reason reconstruction was needed in the first place.
Frequently asked questions
What is the difference between a skin graft and a flap?
A graft is tissue transplanted without its own blood supply, relying on the wound bed to revascularise it — it needs a healthy, well-vascularised base. A flap brings its own blood supply, so it can cover wounds with exposed bone, tendon, or poor blood flow that a graft cannot survive on.
How long is recovery after flap surgery?
Initial monitoring is intensive (often days in hospital watching flap blood flow), with return to normal activity typically over several weeks depending on the flap size and location.
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