Plastic Surgery/RE: Skin Flap


QUESTION: Good Evening Dr. Engler,
Two weeks ago I had surgery for invasive squamous cell carcinoma. A skin flap had to be done to cover the area.  After one week, the dressing was removed and it was healing beautifully. A wrap was reapplied and I was instructed to return in one week for another dressing change. When I returned today (now two weeks since surgery) the wrap over the flap had dried blood on it. I told the nurse the wrap was probably dried onto the skin flap. She hurriedly unrolled the wrap and pulled back the skin flap making it lay back upon itself on the wrap, completely removing about one inch of the two inch flap. She then took the same gloved hand that had unwrapped the dirty bandage and used her fingers to put the skin flap back onto the wound.
What do you think of this?  Should I be concerned about infection?
Thank you for your opinion.

ANSWER: from Dr. Alan Engler

Hi Patty,

I'm sorry to hear this.  You need to contact your surgeon right away and be seen as soon as possible.  It may be advisable to have some stitches put back in to help that flap readhere.  I can't really say without seeing you but that may be the best thing to do at this time.

And I would have all future followup, at least for the first few weeks after the surgery (if you have another procedure) with the operating surgeon, if at all possible.

I hope that this helps and good luck,

Dr. E

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Thank you for your quick and informative response.  However, your answer has given me even more concern for my skin flap.

My surgeon is aware of the situation.  He told me he would have handled the dressing change in the same manner. He viewed the flap shortly after the nurse pulled off the wrap, told me it would continue to heal, and instructed me to return in four months. I uncovered the flap this evening for the first time since the nurse's dressing change, and was in tears when I saw the flap site. One week after surgery the skin borders were touching and healing so well. Now, you can see the flap no longer covers the area.

May I impose upon you to view the attached two pictures and advise me what I should do? I don't want to lose the flap. I am desperate for help.

Most gratefully yours,

I'm sorry I didn't get back to you sooner; I just noticed this as an unanswered question.

It actually looks pretty good to me.  I obviously can't tell for sure but I think that it will heal up pretty well.  Maybe you can go back sooner than four months, though, or consider obtaining a second opinion in the interim?

Again, I hope that this helps.

Dr. E

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Alan M. Engler, MD, FACS


Dr. Engler has answered over 6500 questions on social media sites, including over 3500 on AllExperts alone. His expertise includes breast surgery (breast enlargement with implants, breast reduction, breast lifts), liposuction, eyelid surgery, tummy tucks, facelifts, lipomas, skin cancers, cysts, etc. Dr. Engler has been listed as one New York`s Top Doctors, and as "One of the World's Most Famous Aesthetic Surgeons" (Aesthetic Surgery, TASCHEN Books, Angelika Taschen, Editor). He is the author of 4 books, including "BodySculpture" (a best-selling plastic surgery book on breast surgery, liposuction and tummy tucks), "EyeScapes" (Plastic Surgery of the Eyelids), "Restylane," and "The Slim Book of Liposuction." Dr. Engler has two US Patents for surgical instruments that he's designed, and has appeared on numerous television shows, including The Tyra Banks Show, The Ricki Lake Show (four times), the Dr. Keith Ablow Show and Jerseylicious. Videos of his appearances are available on YouTube (search for "DR. ENGLER"), and his discussion of breast implants, also on YouTube is "How to Choose a Breast Implant." His website is Follow Dr. Engler: @AlanEnglerMD


Dr. Alan Engler is a board-certified plastic surgeon in New York and the author of BodySculpture - Plastic Surgery of the Body for Men and Women (ISBN 0966382749) one of the top-selling plastic surgery books on,, as well as EyeScapes - Plastic Surgery of the Eyelids.

Dr. Engler graduated from Yale University (BA, Russian Studies) and the Columbia University College of Physicians and Surgeons (MD). He did his residency training in General Surgery and, after that, Plastic Surgery, at the Montefiore Medical Center in New York. He is on the faculty of the Albert Einstein College of Medicine in New York in the Departments of both Surgery (Plastic Surgery) and Medicine (Dermatology), and is a Special Lecturer in the Department of Dermatology at Columbia University in New York. He has admitting privileges at Beth Israel Medical Center and Montefiore Medical Center, both in New York.

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