surgical wound care

Do You Have Skin Flap Necrosis?

Once surgery is over, people are usually ready to recover as quickly as possible so they can get back to their normal routine. While they often follow their doctor’s instructions for healing, they sometimes do not recover as quickly as they should.  Skin flap surgery is no different.  While there are many reasons people may not heal quickly and correctly after this surgery, one of them is due to skin flap necrosis.

What is skin flap necrosis and how do you know if you have it?

Skin flap surgery is done to treat large wounds that cannot be closed by other treatments.  Skin flap necrosis is caused by a lack of blood and oxygen to the tissue and may be evident by the 2nd to 4th day following surgery. It often shows as an area of darkness or blood-stained blister on the leading edge of the flap. A doctor or wound care specialist evaluation is required to identify skin flap necrosis.

What causes skin flap necrosis?

Skin flap necrosis is caused by skin flap ischemia. Skin flap ischemia is caused by the inadequate blood supply to the skin flap leading to hypoxic tissue. Hypoxia is a condition in a region of the body which indicates a lower-than-normal oxygen content and pressure in the cells of the tissue.

How can necrosis be treated and by whom?

Surgeons, in conjunction with a Hyperbaric Oxygen Therapy (HBOT) and wound care clinic, can treat skin flap necrosis. HBOT can help prevent the progression of skin flap ischemia to skin flap necrosis. Surgical debridement of necrotic tissue may be necessary. Debridement used in conjunction with Hyperbaric Oxygen Therapy in compromised wounds includes increasing wound oxygen levels, stimulating healing, and improving blood vessel growth and circulation.

How can you prevent or reduce your risk of skin flap necrosis after surgery?

Unfortunately, there is not a lot you can do to prevent skin flap necrosis. Although, if you are a smoker, smoking cessation may reduce the risk. If you believe you may have skin flap necrosis, we recommend that you be evaluated by a wound care specialist to see what advanced treatment options may be best for you.

The experts at R3 Wound Care and Hyperbarics specialize in wound healing, including skin flap treatments, to ensure your wounds are treated quickly, efficiently, and safely.  Call 817-337-6604 to learn more or visit the R3 locations near you to schedule your first appointment.

Written by Quanah Franklin, PA-C, R3 Wound Care and Hyperbarics


Francis A, Baynosa RC. Hyperbaric Oxygen Therapy for the Compromised Graft or Flap. Adv Wound Care (New Rochelle). 2017;6(1):23-32. doi:10.1089/wound.2016.0707

Rangaswamy M. Minimising complications in abdominoplasty: An approach based on the root cause analysis and focused preventive steps. Indian J Plast Surg. 2013;46(2):365-376. doi:10.4103/0970-0358.118615