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Closure or Reconstruction Using a Local Flap: A Guide to Care

This information will help you learn about your surgery using a local flap at Memorial Sloan Kettering Cancer Center (MSK), including what to expect after your surgery. 

A flap is made by taking tissue from one part of your body (called the donor site) and moving it to the surgical site that needs to be covered (called the reconstruction site). With a local flap, the tissue that is used remains attached to the body, bringing its own blood supply. The other end of the flap is separated from the original site. This end is turned to cover the surgical site.

If extra skin is needed to cover the surgical site, it will be taken from another area, usually the thigh. This is called a skin graft. Your surgeon will talk with you about the plan for your surgery.

Local flaps can be used for reconstructing different areas of the body. These include the head, neck, chest, or breast areas, arms and legs, and the lower back, the buttocks, or the vagina

Before Your Surgery

You will have a presurgical testing (PST) appointment. During this appointment, you will meet with a nurse practitioner. He or she will review your medical history with you. You will have tests, including an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, and any other tests necessary to plan your care. Your nurse practitioner may recommend you see other healthcare providers, if needed.

You will be given the resource Getting Ready for Surgery, which has important information on how to prepare for your surgery. 

After Your Surgery

When you wake up after your surgery, you will be in the Post Anesthesia Care Unit (PACU). Once your healthcare providers feel you are ready, family and friends can visit you.

You will have an oxygen mask covering your nose and mouth. A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels.

You will have a Foley® catheter in your bladder to monitor the amount of urine you are making. It will be removed 1 to 2 days after your surgery.  You will also have compression boots on your lower legs to help your circulation. You will have an intravenous (IV) line to give you fluids and medications as needed.

Once you are fully awake, your oxygen mask will be taken off. You will receive oxygen through a thin tube that rests below your nose called a nasal cannula.

 

What to Expect After Specific Surgeries

Reconstruction on your head and neck area

  • After head and neck surgery, swelling is very common.
  • While you are in your hospital bed, your head will be elevated to help prevent additional swelling.
  • You may need to sleep without a pillow to keep your neck from twisting, which can put pressure on your flap and affect blood supply.
  • You may need to continue sleeping with your head elevated for the first couple of weeks after you are discharged from the hospital.

Reconstruction on your arm or leg

  • You may get a cast, splint, or sling. This is to keep your surgical site from moving.
  • You must keep the arm or leg on the side of your surgery elevated at all times.
  • If your local flap is on your legs or feet, you will be told by your healthcare provider when you can dangle your legs or walk.
  • Your case manager will arrange for you to have a wheelchair, walker, crutches , or a raised toilet seat before you leave the hospital if needed.
  • If needed, you will meet with a physical therapist before your surgery. He or she can teach you how to walk with crutches.

Reconstruction of your chest or breast(s)

  • Your doctor may put a loose surgical bra on you in the operating room to hold the dressing around your upper chest, back or both.
  • If your abdominal muscle was used to reconstruct your chest, you may have a loose binder around your abdomen to give extra support to the donor site.

Reconstruction of your lower back, buttock(s), or vagina

  • You may have a loose binder around your abdomen after your surgery to hold your bandages in place.
  • You may be placed on a special bed that has an air mattress. This will help prevent direct pressure on your incision (surgical cut) sites. Your nurse will also position you on the side of your body that was not operated on.
  • You may be allowed to walk 2 or 3 days after surgery. However, you may be told not to sit until several weeks after surgery. This is to prevent putting too much pressure on your donor site incision. You may also be told to lie down on the back seat of your car when you leave the hospital. For longer rides, you may want to use an ambulance.

Commonly Asked Questions

At the hospital

Will I have pain after surgery?

You will have some pain after your surgery. Your doctor and nurse will ask you about your pain often. You will be given medication to manage your pain as needed. If your pain is not relieved, please tell your doctor or nurse. It is important to control your pain so you can cough, breathe deeply and get out of bed and walk.

How do I care for my surgical sites?

The care of your donor and reconstruction surgical sites will vary depending on your surgery.

  • If you have only a line of sutures (stitches), keep the area clear and dry until your healthcare provider has told you that it is okay to shower.
  • If you had skin graft done during your surgery, a large dressing will be used to cover the site. The dressing will be removed 5 to 7 days after your surgery. You will receive a resource called Split Thickness Skin Graft and additional instructions from your nurse about how to care for your surgical sites.

No matter how your surgical site was closed, you should avoid any activity that will cause pulling on the site.

How long will I be in the hospital?

This depends on what kind of surgery you had. It can range from 3 to 14 days.

What should I bring to the hospital to wear home?

When you leave the hospital you should wear clothing that is loose and comfortable. If you will be traveling by car, place a small pillow or towel in between the seat belt and your incision.

At home

What guidelines should I follow for my surgical site once I leave the hospital?

  • Do not expose your surgical sites to sun. Once your incisions have completely healed, apply PABA-free sunscreen with an SPF of 30 or higher to the surgical sites.
  • Once your incisions have completely healed, you can use make up to cover them up.
  • Do not place direct heat or cold (e.g., hot water bottles, heating pads, or ice packs) on your surgical sites.
  • Avoid hot tubs and swimming pools until your incisions have completely healed. Avoid staying in saunas and steam rooms longer than 5 minutes at a time until your incisions are healed.
  • If you shave, use an electric razor on and around the local flap area. Do not shave over the suture lines while your sutures are still in place.
  • Do not use the following on any suture lines until they are completely healed:
    • Perfumes
    • Colognes
    • Aftershave
    • Moisturizers

When will my sutures be removed?

For most patients, sutures will be removed 1 to 2 weeks after surgery. If you have had radiation to the area in the past, your sutures may need to stay in longer. Your sutures may also need to stay in longer depending on how well your incisions are healing.

You may feel numbness or tingling at your surgical site. This should improve over time. You will have scars at your incision sites.

What exercises can I do?

Your doctors and nurses will give you instructions on what exercises and movements you can do while your incisions are healing. This will depend on the type of reconstruction that you had. Ask your doctor or nurse before starting more strenuous exercises, such as running, jogging, or lifting weights.

How can I cope with my feelings?

You may have strong feelings about any permanent changes. These changes can affect the way you feel about yourself. They can have an impact on your emotional and mental well-being. They may also affect your sense of identity and sexuality. If you would like counseling, your nurse can make a referral for you. You can see a social worker, psychiatrist, or psychologist.

In addition, you may find it comforting to speak with a cancer survivor or caregiver who has been through a similar treatment. Through our Patient-to-Patient Support Program, you can speak with former patients and caregivers. To learn more about this program, please call (212) 639-5007.

Our Resources for Life After Cancer Program (RLAC) provides support services after your treatment is finished. To learn more about their services, call (646) 888-4740.

When is my first appointment after surgery?

You will have follow-up appointments with your primary and reconstructive surgeons 1 to 2 weeks after discharge.  Call each surgeon's office to schedule the appointments once you’ve been discharged.