Flap Surgery in Kogarah, Newtown, and Miranda – Dr Ilias Kotronakis

The simplest way to close a defect after skin cancer removal or trauma is to use stitches to bring the wound edges together in a straight line (primary closure). However, when there is a large amount of missing skin or the area has limited skin laxity, a flap may be recommended. A flap is a section of skin, and sometimes fat or muscle, that is partially detached and repositioned to cover the wound while maintaining its own blood supply. This technique can help maintain contour and reduce distortion of surrounding structures.

You will have a consultation with Dr Kotronakis at one of his consulting locations in Kogarah, Newtown, or Miranda. During this consultation, your medical history will be reviewed, and an examination of the affected area will be performed. A flap repair may be recommended if the wound is expected to be large, or if primary closure could result in functional or aesthetic distortion. Flap surgery is commonly used on areas such as the face, scalp, legs, and hands.

Dr Kotronakis performs flap surgery in licensed private or public hospitals. The procedure may be carried out under local anaesthesia with sedation or under a general anaesthetic, depending on the location and size of the flap. Your anaesthetist will discuss the most suitable and comfortable option for your procedure.

If a flap repair is performed on the leg, you may need to keep the leg elevated for up to a week to reduce swelling. In some cases, this is best managed in the hospital. Flap repairs on other parts of the body may allow for same-day discharge, provided safe support is available at home.

A protective dressing will be placed over the flap to support healing and maintain cleanliness. Dr Kotronakis will provide detailed aftercare instructions, including when to return for wound checks and suture removal, usually within 5–10 days. The flap will continue to strengthen over the next three months, and scar maturation may take longer. It is important to avoid strenuous activity and swimming until advised it is safe.

Flaps can appear swollen or bruised immediately after surgery, which usually improves over several weeks. Some flaps may remain slightly raised or ‘pincushioned’ for a few months. Dr Kotronakis will discuss what to expect and any recommended measures, such as massage, to help reduce swelling and support healing.

Scar management may include keeping the wound clean and dry initially, followed by the application of petroleum jelly to maintain moisture. Once the wound is well-healed, silicone-based products such as gels or sheets may be recommended to help reduce redness and improve scar texture. These products can be purchased from pharmacies.

Local anaesthetic is used during surgery to keep the area comfortable. Some numbness can persist after the anaesthetic wears off, and this can persist. However sensation may return gradually over weeks or months, depending on the flap size and location.

A skin graft is a thin layer of skin moved from one area of the body to another, relying on the new site to grow a blood supply. A flap maintains its own blood supply and is typically thicker, providing better contour and colour match. Flap surgery generally involves more complex planning and technique than a skin graft.

Most people can return to light activities, including driving, within a few days, depending on the flap location. Those with lower limb flaps are encouraged to keep the leg elevated as much as possible to aid healing. More strenuous activities, such as heavy lifting or high-impact exercise, should be avoided until the flap is fully healed, which may take several weeks.

All surgical procedures carry potential risks. Risks specific to flap surgery may include infection, bleeding, delayed wound healing, partial or total flap loss, contour irregularities, scarring, and changes in sensation. Dr Kotronakis will discuss these risks with you in detail, taking into account your health status and the complexity of the procedure.

Dr Ilias Kotronakis is an Australian-trained Specialist Plastic Surgeon with a Fellowship of the Royal Australasian College of Surgeons (Plastic Surgery). He consults in Kogarah, Newtown, and Miranda, and performs flap surgery at accredited hospitals. His surgical practice includes reconstructive surgery for skin cancer and trauma, with a focus on techniques that aim to restore both function and appearance.

A consultation with a qualified Specialist Plastic Surgeon is the best way to determine the most suitable reconstructive option for your needs. For more information about flap surgery and reconstructive techniques, you can visit the Australian Society of Plastic Surgeons website.

1. Infection: Any surgical procedure has the risk of infection. Surgeons take precautions to minimise this risk, such as sterile operating environments and proper wound care, but infections can still occur.

2. Scarring: Scarring is an inherent risk of plastic surgery. While surgeons strive to minimise visible scarring, some procedures may result in more noticeable or keloid scars.

3. Pain and discomfort: Plastic surgery involves incisions and tissue manipulation, which can lead to post-operative pain and discomfort. The level of pain varies depending on the procedure and the individual’s pain tolerance.

4. Hematoma and seroma: Hematomas are collections of blood that can form under the skin after surgery, while seromas are collections of fluid. These fluid collections may require drainage.

5. Nerve damage: Nerves can be damaged during surgery, leading to temporary or permanent numbness, tingling, or loss of sensation in the affected area. Nerve damage can also cause muscle weakness or paralysis.

6. Blood clots: Surgical procedures carry a risk of blood clot formation, particularly in the legs. Blood clots can be serious if they travel to other parts of the body, causing complications like pulmonary embolism.

7. Anesthesia risks: Plastic surgery usually requires the use of anesthesia, which carries its own set of risks. These include adverse reactions to anesthesia, breathing difficulties, and, in rare cases, life-threatening complications.

8. Unsatisfactory results: Plastic surgery outcomes may not meet the patient’s expectations or desires. It’s important for individuals to have realistic expectations and to communicate clearly with their surgeon about their goals and desired outcomes.

9. Revision surgery: In some cases, additional surgery may be required to achieve the desired results or to correct any complications or unsatisfactory outcomes. This can increase the financial and emotional burden on the patient.

10. Psychological and emotional effects: Plastic surgery can have psychological and emotional impacts, both positive and negative. While many people experience improved self-esteem and body image after surgery, others may struggle with unrealistic expectations, body dysmorphia, or dissatisfaction with the results.

It’s crucial for individuals considering plastic surgery to consult with a qualified and experienced plastic surgeon who can thoroughly explain the risks and benefits specific to their desired procedure. Understanding and carefully weighing these risks against the potential benefits can help individuals make informed decisions about whether to proceed with plastic surgery.