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Reconstruction after BCC surgery – local flap

Basal cell carcinoma surgery can sometimes leave a wound that is not suitable for direct closure. This might be because it is too large to close, and there is not enough loose skin in the area. Alternatively the wound might just be able to be closed but would be very tight, or could distort other features (eg eyebrow or lip) if closed directly. In this case, a local flap might be used.


What is a local skin flap?

In surgery, a skin flap is a term used to describe a piece of skin that is lifted and moved from one place to another. Crucially, part of the skin remains attached to where it came from, keeping blood flowing in and out of the skin to keep it alive. Keeping a source of blood flow in and out of the skin is what makes it ‘a flap’. When the skin is moved to a part of the body directly next to it (eg a piece of cheek skin is turned to fill a cheek wound), this is termed a ‘local’ flap. Some fat and/or muscle is often taken with the skin, to help fill the wound and improve the blood flow in the flap.


What types of local flap are there?

There are a number of different types of local flap, and can be described in various ways including the way the flap moves and its shape. Common flap terminology includes advancement, rotation, transposition, rhomboid, ‘V to Y flap’, and ‘H flap’, to name a few. The choice of flap for your BCC wound will often depend on factors such as location and size of wound, looseness of skin in the area, and surgeon experience.


How is a flap stitched in place?

Similar to direct closure of a basal cell carcinoma wound, a flap is often held in place by a few deep dissolving stitches. The skin stitches are usually non-dissolving, but may occasionally be dissolving stitches.


What does a local flap scar look like?

Again, this very much depends on the type of flap being used. A rotation flap may be a long curved scar, while a rhomboid flap leaves a scar that looks a bit like a question mark (or one in reverse). Sometimes, the surgeon may make other cuts or change the shape of the flap slightly so as to leave less noticeable scars.

The flap itself may also swell up to start with. This usually improves in time and goes down within a few months.


Other BCC reconstruction pages

Reconstruction after BCC surgery – secondary intent healing

Reconstruction after BCC surgery – direct closure

Reconstruction after BCC surgery – full thickness skin graft (FTSG)

Reconstruction after BCC surgery – split skin graft (SSG)

Reconstruction after BCC surgery – forehead flap

Reconstruction after BCC surgery – pedicled nasolabial flap


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This information is for general knowledge only and does not replace information provided by healthcare professionals. If you have any concerns about any skin growth, or the treatment options, you should consult a medical professional urgently