A local flap is a piece of skin and underlying tissue that is moved from immediately beside the wound to cover it, while staying attached to its own blood supply. Because the skin comes from right next door, it matches the colour, thickness and texture of the area almost exactly. For facial reconstruction after skin cancer removal, a well-planned skin flap on the face is usually the most natural-looking repair available.
Planning local flaps is core plastic surgery. Miss Rakhee Nayar is one of a small number of UK consultants dual-trained in both Mohs micrographic surgery and plastic surgery, which means the reconstruction is designed by the same surgeon who removed the cancer and knows exactly what has been taken.
When a local flap is used
- The defect is too large or too deep for direct closure.
- Closing directly would pull on the eyelid, nostril rim or lip and distort it.
- A graft would leave an obvious patch of mismatched colour or texture.
- The area needs bulk restoring as well as surface cover, such as the side or tip of the nose.
Types of local flap
Flaps are described by how the tissue moves. Advancement flaps slide forward. Rotation flaps pivot around a point. Transposition flaps lift over a bridge of intact skin into the defect. Which one is chosen depends on where the spare skin is, where the scars can be hidden and which nearby features must not be pulled out of position.
Two flaps used often on the nose have their own pages: the nasolabial flap and the forehead flap.
What the procedure involves
Most local flaps are performed under local anaesthetic on the same day as the Mohs surgery, once clear margins are confirmed. The flap is designed and marked, raised carefully to protect its blood supply, moved into the defect and stitched in layers. The area the flap came from is closed at the same time, usually in a line that falls within a natural crease.
Healing week by week
- Days 1 to 5. Swelling and bruising peak, then start to settle. The flap may look darker or pinker than the skin around it while its circulation adjusts.
- Days 5 to 14. Stitches are removed. The scar lines are red and slightly raised.
- Weeks 3 to 12. A degree of firmness and puffiness under the flap is normal and settles gradually.
- Months 3 to 12. Colour blends, contour refines and scars pale. Occasionally a small revision is offered later to thin the flap or soften a step in the contour.
Book a consultation
To discuss Mohs surgery and reconstruction with Miss Nayar, please use the contact form or call the clinic directly.