Dermatologic surgery for skin cancer sometimes uses skin flaps for reconstruction, which involve moving a section of skin with its own blood supply from an adjacent area to cover a wound. Unlike skin grafts, which are fully detached, flaps remain partially connected to their donor site to maintain their blood flow until the wound has healed. This technique is effective for closing deep or complex defects and often results in better color and texture matching compared to grafts.

How skin flaps work:
Blood supply: The flap is taken from a nearby area but is not completely separated. It remains attached by a “pedicle,” a bridge of tissue that provides blood flow.
Positioning: The flap is moved to cover the defect left by the excised skin cancer and is then stitched into place.
Healing: Over time, new blood vessels grow from the recipient site to nourish the flap, allowing it to become independent of its original blood supply.
Multi-stage procedures: For larger or more complex repairs, a two-stage procedure may be necessary. In the first stage, the flap is moved over a bridge of skin; in a second stage, after a few weeks, the pedicle is cut and the flap is fully inset.
When flaps are used
Complex or deep wounds: Flaps are necessary when the wound is too large or deep for the edges to be pulled together directly.
Reconstruction after Mohs surgery: Local flaps are a very common option for closing the wounds left by Mohs micrographic surgery for skin cancer.
Cosmetic and functional results: Flaps are often preferred when a good cosmetic outcome is desired, as they can provide a better match in terms of skin texture and color than a skin graft.
Types of flaps
Advancement flaps: Tissue is moved directly forward to cover the defect.
Rotation flaps: Tissue is rotated around a pivot point to cover an adjacent defect.
Transposition flaps: Tissue is moved over an island of normal skin.
Interpolation flaps: A two-stage process where tissue is moved across normal skin and the pedicle is later divided.

Dermatosurgery/dermatological surgery/skin flaps:

1) Melolabial advancement flap in a patient with skin cancer

2) Double rotation flap / Yin-Yang flap in a patient with skin cancer

3) Shark flap for a patient with skin cancer in the nose area

4) Dermatological surgery/ island (skin) flap in a patient with skin cancer near the eye

5) Dermatological surgery/modified Yin-Yang (skin) flap in a patient with an atheroma in the back area

6) Dermatological surgery/double hatchet flap in a patient with a scalp tumor

7) Dermatological surgery – Yin-Yang flap in a patient with a skin tumor on the lower limb