Flap surgery involves repairing a defect in an area of skin deficiency by moving tissue from an adjacent area with relative skin laxity. Flaps are defined by the fact that they maintain a continuous blood supply to nourish the tissue used for the repair. They are commonly described as being rotation, transposition or advancement flaps.

Flap repairs can have many advantages.

• They utilise repairs from adjacent areas of skin so the colour and texture of the wound closely matches the tissue removed.
  
• They also carry with them a functioning blood supply and heal quickly.

	Melanoma of scalp (above ear) and rotation flap plan.
	8 weeks after surgery.
	There are many other forms of flap repair. This is a transposition flap

Grafts usually need to be protected (splinted) for some time whilst the transferred skin fuses with the wound and re-establishes a blood supply to nourish the tissue. Skin grafts on the lower leg are especially problematic as they usually require the patient to rest in bed with the leg elevated for several (3 -7) days while the blood supply is established. Flaps, such as illustrated below, have the advantage of faster mobilisation (less time in bed) and a better cosmetic result. Unfortunately not all wounds and legs are suitable for these flaps, but where possible offer improved outcomes.

	This patient has a superficial (early) form of melanoma requiring excision with 10 milimeter clearance
	Excision is planned together with flap (Keystone) repair
	Melanoma has been excised and flap repair is in progress
	Repaired wound at completion of surgery