In short. The three families of local flap, advancement, rotation and transposition, and why moving skin with its own blood supply usually beats a graft on the face.
Key points
- Skin differs across the face in colour, thickness, sebaceous quality and the direction its pores run.
- A graft taken from the thigh never quite blends into the nose or the cheek, and it tends to contract and shine.
- A local flap brings skin from immediately beside the defect, so the colour and texture match is far closer, the contour is more natural, and contracture is much less likely.
Some defects cannot be closed directly and should not be covered with a graft. When that happens, the surgeon moves a piece of skin and the tissue beneath it from next door, keeping its blood supply attached. This is a local flap. Because the flap arrives with its own circulation already running, it does not have to survive the precarious first week that a graft must survive, and it behaves much more like the skin around it.
Three families
An advancement flap slides tissue straight forward into the defect, usually after the surgeon has created a releasing incision behind it. A rotation flap pivots a curved segment of neighbouring skin around a point, closing a round or triangular defect and placing the tension along a curved scar. A transposition flap lifts tissue and moves it across intervening skin, as the classic rhomboid flap does, leaving a scar pattern that deliberately breaks up the line.
Why the categories matter to the plan
The shape of the defect, the direction of the lines of least skin tension, the laxity of nearby tissue, and the position of the free margins — the eyelid, the lip, the rim of the nose, the ear — determine which family can be used safely. Drawing the flap on paper, or on the skin before the incision, is routine, because a flap either fits or it does not.
On the face, a flap usually beats a graft
Skin differs across the face in colour, thickness, sebaceous quality and the direction its pores run. A graft taken from the thigh never quite blends into the nose or the cheek, and it tends to contract and shine. A local flap brings skin from immediately beside the defect, so the colour and texture match is far closer, the contour is more natural, and contracture is much less likely. The trade-off is a longer scar pattern and a slightly longer operation. On the eyelid, lip, nose, ear and cheek, the flap is usually the better answer.
What to expect
Most local flaps are performed under local anaesthesia with or without sedation. The flap is designed so that no part of its base is under too much tension, and the resulting scar is typically longer than the defect itself. Flaps can fail partly at the tip if the blood supply is marginal, especially in smokers and in people with poorly controlled diabetes. The scar matures over twelve to eighteen months, the same as any other scar.
Honest limits
A local flap is only available if there is enough loose tissue nearby, and it is not suitable for every site. Using the flap leaves a scar where the flap came from, sometimes in a less flattering position. Results depend on the individual defect rather than on the technique alone, and the final judgement is made at six to twelve months.
Seek review promptly if
- The flap turns deep purple, dusky grey or black at its tip, or becomes cool to the touch.
- Sudden swelling, a tight feeling or bleeding under the flap develops in the first two days.
- Fever or spreading redness appears, or the flap stops bleeding when pricked with a needle.
Frequently asked questions
What are the three families of local flap?
An advancement flap slides tissue straight forward into the defect. A rotation flap pivots a curved segment of neighbouring skin around a point. A transposition flap lifts tissue and moves it across intervening skin, as the rhomboid flap does, leaving a scar pattern that deliberately breaks up the line.
Why is a flap usually better than a graft on the face?
Because facial skin differs in colour, thickness and pore pattern. A graft from the thigh never quite blends into the nose or cheek and tends to contract and shine. A local flap brings skin from immediately beside the defect, so colour and texture match far better and contracture is much less likely.
Can a local flap fail?
Yes, partly, most often at the tip if the blood supply is marginal, particularly in smokers and in people with poorly controlled diabetes. A local flap is also only available if there is enough loose tissue nearby, and using it leaves a scar where the flap came from.
Risks & Limitations
- Partial or complete failure of a graft or flap, which may need further surgery.
- Donor-site scarring, delayed healing and pain. A donor site leaves its own permanent scar.
- Infection, bleeding under a graft, or fluid collecting beneath a graft or flap.
- Contracture, and recurrence of contracture after a release procedure.
- Reconstruction is usually staged: more than one operation and months of healing are normal.
- Colour, texture and contour mismatch between reconstructed skin and the surrounding area.
- Reduced or altered sensation in grafts, flaps and donor sites.
- Scars are permanent. They mature and fade but never disappear.
- Final assessment is made at 6–12 months, and longer in growing children.
When to Seek Care
- A graft or flap that turns dark, cold, dusky, purple or black, or stops bleeding when pricked.
- A dressing soaked with blood, or bleeding that does not stop with gentle pressure.
- Fever above 38 °C, or spreading redness, warmth or discharge around a wound.
- New or severe pain, or rapid swelling under a graft or flap in the first days.
- A limb that becomes pale, cold or numb after flap surgery.
- Any change in a grafted or flap-covered area that concerns you, however minor.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) — reconstructive surgery and skin graft guidance
- Cochrane Library — systematic reviews in wound care and surgical reconstruction
- Wounds International — wound bed preparation and graft survival guidance
- Chinese Medical Association, Plastic Surgery Branch — clinical guidance
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.