It is a type of plastic surgery that involves transporting healthy, live tissue from one location of the body to the areas that have lost skin, fat, muscle movement, and/or skeletal support. The site from which the tissue is obtained is called the donor site, while the site where the tissue is transferred is called the recipient site. Flaps are different from grafts as they have their own blood supply, that is, their own artery and vein. Grafts are also used to cover open wounds but they do not have their own blood supply. They may
undergo contractures. The donor and recipient skin may not match completely, resulting in cosmetic problems. A flap may contain a single type of tissue or multiple types depending on the tissues contained in the flap It could be bone/soft tissue flap – when bone and the overlying skin are transported to a new location, musculocutaneous flap (muscle and skin flap) – when the area to be covered needs more bulk and an increased blood supply.
There are several indications for flap surgery to cover open deep wounds in patients with burns or accident victims with major tissue loss and deeper structures are exposed like the bone, cartilage, tendon, joint, major blood vessels or nerves. Flaps may also be used in patients who have undergone surgical removal of the cancer. There are several different types of flap surgery methods that may be utilized, depending upon the location of the flap and the structures that need to be repaired or covered. Main types include free flaps and pedicelled flaps.

The flap with its blood vessel is disconnected and then attached to a blood vessel at a recipient site. (From one site of the body to another site). Microsurgery is used to attach the blood vessels.
Pedicelled flap: Flap that has its blood supply with at least one artery and one vein. Types of pedicelled flaps include the following:
Local flaps are used from adjacent tissues. However, they can only be used for small to medium sized defects, and only locally.
Regional Flaps: A section of tissue can be used as a regional flap that is attached by a specific blood vessel from other region of the body close to the required area.

Pre-operative Check-ups and routine tests are ordered a few days before the surgery. Routine Tests: Blood tests like hemoglobin levels, blood group, and liver and kidney function tests, urine tests, ECG, chest x-ray and detailed assessment of the heart (may be required) in older group of patients, to make sure that they are fit for surgery. Specific Tests: Doppler: The blood supply to the selected donor area is assessed using Doppler. It is a simple, painless test
similar to an ultrasound that checks the blood supply to a particular part. Other tests like MRI or CT angiogram have also been used to assess the blood supply to the flap. Need to avoid smoking cigars, pipes and cigarettes as it may affect the formation of new blood vessels on the flap and wound site. Certain medicines, such as steroids and blood thinners, may delay wound healing. Certain diseases, such as diabetes carefully control your blood sugar
carefully. People with diabetes may have poor wound healing. Admission is usually required a day before the surgery. Flap surgery may be done under general anesthesia (overnight fasting is required and occasionally intravenous fluid maybe required to keep you well) or local anesthesia depending on the extent of the procedure.

The donor site may also be closed with sutures, with an effort to have a minimal cosmetic effect or a skin graft is placed if necessary. The donor and recipient sites are covered with dressing. May need to keep in Intensive care unit or high dependency unit for 24 to 48 hours after surgery. Painkillers are prescribed depending on the extent of the pain. Antibiotics are also prescribed to prevent infection. Some flaps may have tubes to drain out excess fluid or blood from recipient or donor sites. For better wound healing and rapid recovery: limit movements such as stretching, to prevent bleeding, shearing, and swelling in the wound and flap sites. Taking vitamins and eating healthy foods high in protein may improve wound healing.

All operations carry risks, such as bleeding and infection etc. all of these risks will be explained to you in detail before you sign the consent form. Possible complications of flap surgery include Bleeding, Infection, Seroma formation (collection of excess fluid) – required drainage, Wound edges separation (dehiscence), Donor site infection, Seroma formation, graft loss. Reduced blood supply due to spasm of the feeding artery or development of blood clot in vessel supplying or draining the flap. Venous congestion due to reduced outflow through the veins. If this occurs, it usually happens within the first two days and means that you will have to return to the Operating Theatre to have the clot removed. Removing the clot is not always successful and, on these occasions, the flap ‘fails and an alternative method of reconstruction sought. Seek care immediately if developing fever, swelling at flap site and not going back in, pain at donor or flap site that does not go away, sudden breathing difficulty or shortness of breath, dressing soakage with blood, discharge from flap site or donor site i.e. blood, pus, or a foul- smelling odor.