What Is Flap Reconstruction?
Flap reconstruction is a surgical procedure plastic surgeons sometimes uses to close wounds of various sizes. During flap reconstruction, your plastic surgeon will take healthy, live tissue from one place on your body (donor site) and move it to another place (recipient site). This procedure treats areas that have lost skin, fat, muscle movement, or even bone.
Skin Flap vs. Skin Graft
Flaps are similar to skin grafts. However, there are some differences. Skin grafts only include the top layer of skin and do not carry blood. On the other hand, flaps include larger amounts of tissue, such as muscle, fat, or bone. These larger pieces of tissue also carry their own blood supply and can use existing blood vessels to successfully reattach to your body.
Flaps also carry their own blood supply from the donor site to the recipient site. This means they take blood vessels with them and don’t need to develop a new supply in order to successfully reattach to your body. As a result, flaps have a lower failure rate and look better when fully healed than skin grafts.
Types of Flap Reconstruction
There are several different types of flap reconstruction surgery. Your plastic surgeon will determine the best kind for your needs.
These are commonly used types of flaps:
- Local flap—The donor site is located near the recipient site. During the procedure, the flap remains attached to your body at one end and is pivoted or slid to its new location.
- Regional flap—A section of tissue is to cover a larger wound. The flap remains attached to a specific blood vessel and involves a deeper layer of muscle or tissues.
- Microvascular free flap—Like the other types of skin flaps, skin and blood vessels from the donor site are removed and reattached to the recipient site. Your doctor uses microsurgery to reattach the blood vessels once they are transferred to their new location.
Who Needs Flap Reconstruction?
If you’ve had an injury, cancer, or certain types of illness, you may need flap reconstruction surgery. Common reasons for needing flap reconstruction include the following:
- Breast reconstruction
- Injuries
- Skin cancer
- Diabetic wounds
- Complex upper and lower extremity wounds
- Complete brachial plexus injury
- Toe to thumb transfer
- Scaphoid avascular necrosis
- Pressure wound reconstruction
- Trunk and extremity reconstruction
- Reconstruction of facial features and nerves
- Reconstructive procedures on your body
Flap Surgery Cost
Surgery costs vary widely depending on why you need flap reconstruction and what procedure you need. Medically necessary surgeries, such as those related to skin cancer or treating acute injuries are usually covered by insurance policies. Check with our office to determine if your insurance will cover your surgery.
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How to Prepare for Surgery
You will undergo routine testing and questions about your medical history before your flap reconstruction surgery. Tests may include:
- blood tests,
- urine tests, and
- imaging tests, like a chest X-ray and electrocardiogram, to determine if you are healthy enough for surgery.
Ask your doctor what tests you will need and make sure to show up on time for your pre-surgery testing appointments.
As the day of your scheduled surgery gets closer, your surgeon will tell you to stop taking over-the-counter pain relievers that make your blood thinner. Be sure to tell them about any medications you’re taking, including any over-the-counter supplements or herbal products you are taking without a prescription.
You will need to fast for several hours before your surgery. Ask your doctor when you should stop eating and drinking.
Flap Reconstructive Surgery
On the day of your surgery, you will be admitted to the hospital an hour or two before your operating room appointment. A nurse will insert an IV into your arm to prepare for any fluids you may need before, during, or after your surgery.
You will be put to sleep during your flap reconstruction surgery. The surgery takes at least one hour or more, depending on the type and severity of the wound your surgeon is closing.
During the procedure, your surgeon will:
- Mark off the donor site with a special pen.
- Make an incision (cut).
- Remove the flap.
- Suture (stitch or staple) the flap into the recipient site.
If needed, blood vessels are then reattached to the flap using a microscope. This establishes a new blood supply to the flap.
The donor and recipient sites will be covered with gauze, adhesive strips, or a wrap bandage to keep the dressing in place while your wound heals.
After Surgery
Both your donor and recipient site may feel sore as the anesthesia wears off. Your care team will administer painkillers as needed. Your vital signs will be monitored to make sure your body is healing well from the surgery.
You may need to stay in the hospital for a few days after your flap reconstruction surgery, depending on the size of wound treated and the type of flap used.
Flap Reconstruction Recovery
You will need to rest and restrict movement to the areas involved in your surgery. Rest is important to make sure the flap establishes its own blood supply and fully attaches to the recipient site. It is also important to elevate the flap recipient site to help decrease swelling in the area.
Skin Flap Surgery Recovery Time
You will need to take time off work, childcare duties, household tasks, and other daily activities. Depending on the type of flap, full recovery after flap reconstruction surgery can take from six weeks to 3 months. It’s important to allow the flap reconstruction to fully heal before you resume normal activities.
Aftercare Instructions
While recovering from flap reconstruction surgery, it’s important to follow your surgeon’s instructions.
- Do not apply ice or heat to the surgical site.
- Do not exercise or perform strenuous tasks, like reaching high or moving quickly.
- Do not bump or stretch the area.
- Do not soak the skin flap or donor site in a bath for at least two weeks.
Signs of Infection
While you recover, call your provider immediately if you notice any of these signs:
- Fever of 101°F or higher
- Redness or swelling at either the donor or recipient site
- Foul smell coming from the wound
- Discharge or pus leaking from the wound dressing
- Excessive pain or discomfort
How to Make an Appointment
Our plastic surgeons at U of U Health are board-certified and specially trained beyond local and regional standards. Our plastic and reconstructive surgeons provide high-quality care for a wide variety of flap reconstruction needs. No matter your reason for needing or choosing to have flap reconstructive surgery, our skilled providers at U of U Health will deliver quality treatment and follow-up care.
Call 801-581-7719 to schedule an appointment or consultation with one of our plastic surgeons today. Your primary care provider can make a referral for you.