Local flap reconstruction
A way of closing a wound by moving nearby skin, which keeps its own blood supply, to fill the gap — often used on the face after skin cancer removal.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- A local flap moves nearby skin, keeping its own blood supply, to close a wound — often on the face after skin cancer removal.
- Because it brings its blood supply with it, a flap usually matches surrounding skin better than a graft, but it creates extra scar lines.
- Most flaps heal well, but part of a flap can occasionally fail, and this risk is higher in smokers and with larger wounds.
- Scars are placed in natural lines where possible and settle over months, with the final result taking time to appear.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Closes a wound that is too large to stitch directly
A local flap may not be possible if there is not enough nearby healthy, loose skin to move.
Expect swelling and bruising, especially on the face. Keep the area clean and protected and follow any advice on keeping your head raised. Simple pain...
Clear wound-care instructions and a named contact for problems.
Expect swelling and bruising, especially on the face. Keep the area clean and protected and follow any advice on...
Non-dissolvable stitches are usually removed around 5–14 days, depending on the site. Bruising starts to fade and...
Most swelling settles. If the flap is staged (for example on the nose), the second stage is often done around this...
Scars continue to soften, flatten and fade, and the final contour settles. Some firmness or numbness can take many...
What is local flap reconstruction?
A local flap is a piece of skin and the tissue just beneath it that is moved from right next to a wound to fill the gap, while staying attached to its original blood supply. It is one of the main ways surgeons close wounds that are too big to stitch directly, especially on the face after removing a skin cancer.
Because the flap keeps its own blood supply, it usually heals well and tends to match the surrounding skin in colour and texture better than a graft. Surgeons use different designs — such as advancement, rotation or transposition flaps — depending on the size and position of the wound and the natural lines of the face.
A flap is different from a skin graft. A graft is skin moved without its own blood supply, which must 'take' from the wound bed; a flap brings its blood supply with it. This is why flaps are often preferred where appearance matters or where the wound bed would not support a graft.
Flap reconstruction closes the wound and aims for a good result, but it still creates scars and, occasionally, part of a flap can fail to heal. Your surgeon will explain the plan and what to expect.
Types & techniques
There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.
Local flap vs skin graft
| Local flap | Skin graft | |
|---|---|---|
| Blood supply | Keeps its own | Relies on the wound bed |
| Colour/texture match | Usually good (nearby skin) | Often differs |
| Scars | Extra lines near the wound | Patch plus a donor site |
| Best where | Face, visible areas, poor beds | Larger or flatter wounds |
Your surgeon chooses between a flap and a graft based on the size and site of the wound and how the result needs to look.
Preparing for your surgery
- Make sure you understand why a flap is planned, where the extra scars will be, and what the wound is from (for example after skin cancer removal).
- Stop smoking and avoid nicotine if you can — smoking reduces blood supply and increases the risk of part of the flap failing.
- Tell the team about blood-thinning medicines, diabetes, steroids or anything affecting healing.
- Ask whether it will be one operation or staged (some flaps, such as on the nose, are done in two steps).
- Arrange a lift home if you are having sedation or a general anaesthetic.
- Plan some time off, particularly for facial surgery where swelling and bruising are common.
- Have any dressings, pain relief and supplies you are advised to get ready at home.
What happens
Local flap reconstruction is most often done under local anaesthetic, with the area numbed by injection, although sedation or a general anaesthetic may be used for larger or staged procedures. If the flap is closing a skin cancer defect, the cancer is removed (or already has been, sometimes with the margins confirmed first by Mohs surgery).
The surgeon then designs and lifts a flap of skin from beside the wound, keeping it attached to its blood supply, and moves it to fill the gap. Both the flap and the area it came from are stitched, with the scars planned to follow natural creases and lines as much as possible.
Some flaps are completed in one operation; others, such as certain nose reconstructions, are done in two stages a few weeks apart. Most people go home the same day.
Is this operation right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- A local flap may not be possible if there is not enough nearby healthy, loose skin to move.
- Heavy smokers or people with poor circulation have a higher risk of part of the flap failing, which may favour a different approach.
- Where moving nearby skin would distort an important feature (eyelid, lip, nostril), a graft or a staged plan may be safer.
- For very large or deep wounds, a free flap or graft may be needed instead of a local flap.
Delay surgery if…
- There is active infection at or near the site.
- Blood-thinning medicines need adjusting and this has not been arranged.
- Diabetes or another healing problem is poorly controlled.
- You are still smoking and there is time to stop first, to improve flap survival.
- For skin cancer, the margins have not yet been confirmed clear when the plan depends on that.
Alternatives to discuss
- Closing the wound directly with stitches if it is small enough.
- A skin graft when a flap is not suitable or nearby skin is limited.
- Letting a wound heal by itself in selected sites.
- A free flap for very large or complex defects.
- Non-surgical management in selected frail patients.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Anaesthetic choices
The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.
Benefits
- Closes a wound that is too large to stitch directly
- Brings its own blood supply, so it usually heals reliably
- Often matches the surrounding skin in colour and texture better than a graft
- Scars can be hidden in natural facial lines and creases
- Can be done at the same time as removing a skin cancer
Risks & complications
- Bruising and swelling, which can be marked on the face
- Extra scar lines around the reconstructed area
- Tightness, pulling or a change in contour as it heals
- Temporary numbness of the flap and nearby skin
- Part of the flap healing slowly or its edges not healing well
- Infection needing antibiotics
- Bleeding or a collection of blood under the flap (haematoma)
- Pulling on a nearby structure, such as an eyelid, lip or nostril, changing its position
- A raised, thickened or noticeable scar
- Part or all of the flap losing its blood supply and failing (more likely in smokers and larger flaps)
- Needing a further operation or a graft to correct a problem
- Lasting numbness, asymmetry or distortion of a nearby feature
A flap depends on the blood supply it brings with it, so smoking, a large or tight flap, bleeding or infection can all threaten part of it. On the face, a flap can also pull on a nearby structure such as the eyelid, lip or nostril, so the design matters. Choose a surgeon experienced in facial reconstruction, and ask how they plan to place the scars and protect nearby features.
Published figures to discuss
Local flaps on the face generally heal reliably and have lower complication rates than full-thickness grafts in several studies, but outcomes depend on the size and site of the wound, the patient's circulation and whether they smoke. Reported complication rates vary between centres, so figures below are cautious and should not be read as personal risk.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Flap necrosis (part of the flap not surviving) in facial reconstruction | Low — around 3–4% for local flaps in one large series | Lower than for full-thickness grafts (about 18% in the same study); higher with larger tumours and in smokers. | Risk stratification of local flaps and skin grafting in facial reconstruction: 607 patients (PMC)pmc.ncbi.nlm.nih.govPublished figure |
| Major complications (haematoma, necrosis) and tumour size | Higher when the tumour or defect is larger (above about 15 mm) | Larger wounds and certain patient factors raise the risk; based on a single-centre study. | Risk stratification of local flaps and skin grafting in facial reconstruction: 607 patients (PMC)pmc.ncbi.nlm.nih.govSource-linked context |
| Need for revision or scar refinement | Uncommon to common depending on site, tension and cosmetic expectations | Local flaps trade a better closure for extra scar lines; swelling and trapdoor contour can improve slowly. | Risk stratification of local flaps and skin grafting in facial reconstruction: 607 patients (PMC)pmc.ncbi.nlm.nih.govSource-linked context |
| Cancer margin requiring further excision | A minority when reconstruction follows skin-cancer removal | If final pathology shows involved margins, more surgery may be needed even after a good-looking reconstruction. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
Recovery — what to expect, and when
Recovery from a local flap is usually quicker and more comfortable than from a graft, because the flap keeps its own blood supply, but facial swelling and bruising are common in the first week or two.
- Swelling and bruising, particularly around the eyes and cheeks after facial flaps
- Firm, raised or lumpy scar lines that soften over months
- Numbness or odd sensation in and around the flap
- Tightness or a slightly different contour that improves as it settles
- Pink or red scars that gradually pale
Aftercare
- Keep the area clean and follow your wound-care instructions.
- Use simple pain relief such as paracetamol if needed.
- Keep your head raised and avoid bending or straining early on to reduce facial swelling.
- Do not smoke, as this reduces the blood supply the flap needs.
- Avoid knocking, pressing or stretching the flap while it heals.
- Protect the healing scars from the sun.
- Once healed, massage and moisturise scars if advised.
- Attend follow-up so healing is checked and any staged surgery is planned.
- Wound-care instructions understood
- Pain relief at home
- Time off arranged for facial swelling and bruising
- Help at home if a general anaesthetic or staged surgery is planned
- Sun protection for the scars
- Date noted for stitch removal and any second stage
- Clinic contact number saved for problems
Scars and how they heal
A local flap is designed to hide scars in natural creases and lines, such as the side of the nose, the smile lines or the hairline, so they become as discreet as possible. There are usually more scar lines than with a simple stitched closure, because the flap and the area it came from both need closing. Scars are firm and pink at first and soften and fade over months; some can stay slightly raised or noticeable, and sun protection and massage can help.
⚠ Get urgent help if…
- The flap turning dark, dusky, blue or very pale
- Increasing redness, heat, swelling or pus (infection)
- Spreading redness with fever or feeling unwell
- A tense, painful swelling under the flap (possible bleeding)
- Bleeding that does not stop with gentle pressure
- Wound edges coming apart
- A nearby eyelid, lip or nostril being pulled out of position
Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A good result means the wound is closed, the flap heals with a good blood supply, nearby features keep their normal position, and the scars settle into natural lines. Local flaps often give an excellent colour and texture match because they use nearby skin. However, scars take months to mature, some firmness or numbness is normal early on, and occasionally a small revision is needed to refine the result.
If the flap was used after skin cancer removal, the reconstruction does not change the cancer result — the laboratory report on the removed tissue tells you whether the edges were clear.
Once healed, a local flap provides durable, well-matched skin cover that generally lasts well, as it keeps its own blood supply. Scars continue to fade for up to a year or more. If the flap followed skin cancer surgery, the usual skin-cancer follow-up and self-checks still apply, because reconstruction does not affect the chance of the cancer returning or a new one developing.
Combining with other procedures
Local flap reconstruction is very often done at the same time as removing a skin cancer, to close the gap left behind. For high-risk or facial cancers, the surgeon may wait until Mohs surgery has confirmed the edges are clear before reconstructing. Occasionally a flap is combined with a graft for a complex wound. Your surgeon will explain the order and timing for your case.
Follow-up & long-term care
You will usually be seen within a week or two to remove stitches and check healing, with further reviews as swelling settles and any staged surgery is completed. If the flap followed skin cancer surgery, you will also receive the cancer results and a follow-up plan. You should be told how to care for the scars and who to contact with problems.
- Protect the scars from the sun, especially in the first year
- Massage and moisturise scars if advised, to help them soften
- Report any change in a nearby feature (eyelid, lip, nostril) that does not settle
- Continue skin-cancer follow-up and self-checks if the flap followed cancer surgery
Revision and secondary surgery reality
- Small revisions are sometimes done later to refine the scar or contour.
- If part of a flap fails, it may heal with dressings or need a further procedure or graft.
- A feature pulled out of position (such as an eyelid) may need a corrective operation.
- Final scar judgement takes months, so revisions are usually delayed until the scar matures.
Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.
What good aftercare looks like
- Clear wound-care instructions and a named contact for problems.
- Early review to check flap healing, then later review as scars settle.
- A plan and timing for any staged surgery.
- Advice on scar care, sun protection and what to report.
- If cancer-related, a clear results process and ongoing skin-cancer follow-up.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The size and complexity of the wound and the flap design needed
- The site (facial reconstruction near the eye, nose or lip is more complex)
- Whether it is a single or staged operation
- Local anaesthetic, sedation or general anaesthetic, and theatre or facility fees
- Whether it is combined with skin cancer removal or Mohs surgery
- Follow-up appointments, stitch removal and any revision surgery
- The surgeon's fee and what the procedure includes
- Whether a second (staged) operation is included or charged separately
- Anaesthetic or sedation fees
- Facility or theatre fees
- Follow-up appointments and stitch removal
- What happens, and what it costs, if a revision is needed
- If cancer-related, how and when the results are given
On the NHS? Local flap reconstruction is routinely done on the NHS when clinically needed, such as after skin cancer surgery; private care may be used for speed or choice of surgeon.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not explaining that a flap creates extra scar lines compared with a simple closure.
- Not warning that part of a flap can fail, and what that would mean.
- Not discussing the risk of pulling on a nearby eyelid, lip or nostril.
- Implying a perfect, scarless result.
- No clear plan for staged surgery, aftercare or who to contact.
Marketing red flags
- Promising 'scarless' facial reconstruction.
- Not mentioning the possibility of flap failure or revision.
- Downplaying swelling, bruising and the time scars take to settle.
- Before-and-after photos taken at different times, angles or lighting.
- Pushing a particular technique without explaining why it suits your wound.
Choosing a surgeon safely
- Check your surgeon is on the GMC Specialist Register for this area.
- Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
- You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
- Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- Why is a flap better than a graft or direct stitches for my wound?
- Where will the scars be, and how will you place them in natural lines?
- Will it be one operation or staged, and why?
- How will you protect my eyelid, lip or nostril if the flap is nearby?
- What is the risk of part of the flap not healing, and what raises it?
- If this follows skin cancer removal, when and how will I get the cancer results?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my operation, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this operation not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
What is the difference between a flap and a graft?
Will the scars be very visible?
Could the flap fail?
Why might it be done in two stages?
Will it pull my eyelid or lip out of shape?
Can I have this on the NHS?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Skin cancer treatment (surgery and reconstruction) Risk stratification of local flaps and skin grafting in facial reconstruction: 607 patients (PMC) Reconstruction of nasal skin cancer defects with local flaps (PMC) The bilobed flap in skin cancer of the face: 285 cases (PubMed) Non-melanoma skin cancer: UK National Multidisciplinary Guidelines (PMC)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
Related guides: Skin graft · Free flap reconstruction · Basal cell carcinoma surgery · Melanoma surgery (wide local excision) · Scar revision