Flap Surgery

A skin defect due to trauma or skin cancer can be filled by a flap of skin and fat that is adjacent to the skin defect.

The simplest way to close a defect after removal of a skin cancer or after an injury is to use stitches to oppose the wound edges as a straight line (primary closure). If there is a large amount of missing skin or the defect is in an area of limited skin laxity, Dr Kotronakis and Dr Sanki may use a flap of adjacent skin to close the wound. A skin flap is a plastic surgery term to describe a wedge of skin or fat that is designed in a shape that will facilitate its movement into the defect and result in minimal distortion of the area from which it was raised.

How do I know if I need a flap repair?

Dr Sanki and Dr Kotronakis will first meet you for your skin consultation at Kogarah, Miranda, Drummoyne or Newtown. During your consultation, our surgeons will listen to your concerns and goals. While flap surgery is a safe and commonly performed operation, the consultation will be performed with sensitivity to your opinions and thoughtfulness to your concerns. Any additional health problems that might affect your treatment will be identified. An examination of your skin cancer will then follow. A flap will be recommended to you if Dr Sanki or Dr Kotronakis believe that your functional and aesthetic result will be improved by using reconstructive surgery. In general, a flap will be recommended if the wound is expected to be large or in an area where primary closure as a straight line would distort your face or body. Common areas that require flap surgery are the face, scalp, leg and hand.

Will I need to come to hospital for my flap surgery?

Dr Kotronakis and Dr Sanki perform most of their flap repairs in a licenced private hospital or in a public hospital. Flap surgery can be performed under sedation and local anaesthetic or a full general anaesthetic. Your anaesthetist will help you determine which option will be most comfortable for you.

How many days will I spend in hospital?

Patients having a flap procedure to their leg will usually need to keep their leg elevated for one week after surgery to reduce swelling to the flap. This is often best done in hospital to help assist you in your care while you are immobilised. Patients having a flap repair to other parts of their body can generally go home on the same day as their surgery. It is important to organise for someone to take you home.

How long does a flap take to heal?

A protective dressing will be placed over your flap to help its healing and to keep it clean and dry. Dr Kotronakis or Dr Sanki will thoroughly explain the aftercare of your flap to ensure its good healing. Most patients will be asked to return to see our doctors for a wound check and suture removal after 5 to 10 days. After the stitches are removed, your wounds are at their most fragile and it is important to avoid sport and swimming for at least another week. The flap and its wounds become stronger over the next three months. After this, the scars will start their process of resolution and fading.

How will the flap look?

Plastic surgery is based on the principle of minimising the cosmetic and functional consequence of cancer or trauma. Dr Sanki and Dr Kotronakis will consider all options for your reconstruction and help you pick the best procedure to minimise the defect’s effect on your appearance. Our surgeons can show you pictures of other patients who have had similar flap surgery, and will also draw a picture of your expected flap reconstruction. A flap can appear obvious and unsightly straight after surgery, but usually heals with minimal contour deformity. It is normal to have bruising and swelling after surgery and this should pass after two to three weeks. Some flaps continue to stay swollen and can “pin cushion” in the first months after surgery. Sometimes massage is recommended to help reduce flap swelling and to help break down scar tissue.

What can I use to improve the quality of my flap scar?

Our nurses and doctors will guide and explain the role of scar management after your surgery. In general, the wound and flap are kept clean and dry for the first week. After that, Vaseline can be used twice daily on the wound edges as skin prefers to heal in moist conditions. The Vaseline also helps to facilitate removal of your sutures as it lubricates the stitches and helps to remove small scabs. Once your wound is robust and well healed, silicone scar oil or silicone scar tape will be recommended to be used on your wound. The silicone products can be purchased from our Kogarah rooms, your local chemist or online. Silicone products have good scientific evidence for improving scars. Silicone products can reduce the redness, thickness and elevation of a scar. Silicone products should be used for up to 3 months following your surgery.

Will my flap be numb?

Local anaesthetic is used to numb the surgical area so that you are comfortable following your procedure. Some flaps continue to stay numb after the local anaesthetic has worn off. It is usual for sensation to return to a smaller flap over the next few weeks to months. Some larger flaps may continue to have numb patches.

What is the difference between a skin graft and a flap?

A skin graft consists of only a translucent thin layer of skin and must grow a new blood supply from the wound bed that it is transplanted onto. A flap has its own blood supply and is thicker than a skin graft. A local flap is taken from skin adjacent to the defect whereas a skin graft is usually taken from skin from another part of the body. A flap therefore usually restores contour and is a better colour match to the area than a skin graft. A flap requires more surgical planning and expertise than a skin graft.

How long will it be before I can drive, return to work and exercise after skin flap surgery?

Most people having a flap procedure are able to drive and return to work a day after surgery. You may feel self-conscious if you have a dressing on your face, so it is important to consider when you will feel socially comfortable to return to work. Patients having a flap to the lower limb are strongly encouraged to keep their leg elevated as high as possible for as many hours as is possible through the day. Exercise is possible once the flap is well healed eg two to four weeks after surgery.

Which hospitals do Dr Sanki and Dr Kotronakis operate in?

Dr Sanki and Dr Kotronakis are Kogarah and Miranda skin flap specialists, and perform their surgery at major hospital facilities including St George, Hurstville, Bondi Junction and St Luke’s private hospitals. We select our hospitals based on their high standards of peri-operative care and their outstanding surgical equipment.

Who should perform skin flap operations?

A skin flap may sound simple but it is real surgery, and should be performed with sophisticated surgical technique for the safest and best results. It carries real risks, and as such should be considered carefully. Fortunately, skin flap surgery in Sydney is safely performed by our highly experienced surgeons.

A skin flap is only one of many potential reconstructive techniques used by specialist plastic surgeons. It is important to see a plastic surgeon who is able to offer you the very best reconstructive solution to your problem. Make sure your surgeon is able to explain why a skin flap is the most effective reconstruction for your skin cancer or trauma defect.

We recommend that you carefully consider your choice of surgeon. Unfortunately doctors without surgical qualifications beyond their medical degree are allowed to perform surgery. Your surgeon should be appropriately qualified with at least a Fellowship of the Royal Australasian College of Surgeons (FRACS), which means that they have specialist surgical training. FRACS is the standard qualification required in Australia to perform surgery in private and public hospitals.

Members of the Australian Society of Plastic Surgeons have a FRACS and specialised training in Plastic and Reconstructive Surgery, including skin flaps.

Our Sydney skin flap surgeons, Dr Amira Sanki and Dr Ilias Kotronakis are fully qualified Plastic Surgeons. They are both Australian University trained, having received Honours degree in their medical schools. They both have FRACS qualifications as Specialist Surgeons in Plastic and Reconstructive Surgery, and are members of the Australian Society of Plastic Surgeons. They both have extensive experience and training in skin graft surgery, including the most advanced and up to date techniques. They are committed to giving their patients the safest and best treatment available.

Where to get more information

A consultation with a qualified Plastic Surgeon is the best place to get the right advice. More information on skin flaps is available online at the Australian Society of Plastic Surgeons website.

Plastic surgery, like any other surgical procedure, carries certain risks and potential complications. It is important for individuals considering plastic surgery to be aware of these risks before making a decision. Your plastic surgeon will explain the specific risks of your procedure and your risk profile in the context of your general health and the complexity of your procedure. Here are some of the common risks associated with plastic surgery:

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.