Types of Flap Surgery: Free Flaps, Local Flaps, and How They're Chosen

"Flap surgery" covers a family of reconstructive techniques that all share the same basic idea: moving living tissue, with its own blood supply, to repair a defect elsewhere on the body. Which specific type of flap is used depends heavily on the size, location, and cause of the defect.

Local Flaps

Local flaps move tissue from immediately next to a defect, keeping their original blood supply intact by staying attached at a base or pedicle. Common named local flap designs include the advancement flap (tissue slid directly forward to cover a defect), the transposition flap (tissue rotated from an adjacent area), the bilobed flap (two connected transposition flaps used together, often on the nose), and the limberg (rhomboid) flap, a specific rotational design well suited to certain diamond-shaped defects.

Free Flaps

Free flaps involve completely detaching tissue — including its blood vessels — from a donor site and reconnecting those vessels under the operating microscope at the recipient site. This microsurgical approach allows tissue to be moved from almost anywhere on the body to reconstruct complex or distant defects that local tissue simply can't reach.

TRAM and DIEP Flaps

The TRAM (transverse rectus abdominis myocutaneous) flap and the DIEP (deep inferior epigastric perforator) flap both use skin and fat from the lower abdomen — most often for breast reconstruction after mastectomy. The key difference is that a TRAM flap includes abdominal muscle, while a DIEP flap carefully preserves the muscle and takes only the skin, fat, and its blood vessels — generally reducing abdominal wall weakness afterward, at the cost of a more technically demanding dissection.

How the Right Flap Is Chosen

Selection depends on the size and location of the defect, the tissue qualities needed for a good match, and the patient's overall fitness for a longer microsurgical procedure where free flaps are being considered.

See more on the flap reconstruction & microsurgery procedure page.