This is in comparison to a skin graft which does not have its own blood supply and relies on vascularization from the recipient site.

Skin is important for many reasons, but namely its role in thermoregulation, immune function, and blood supply aid in flap survival.

Knowledge of these supply arteries and their associated angiosomes is useful in planning the location, size, and shape of a flap.

[4] Flaps can be fundamentally classified by their mechanism of movement, the types of tissues present, or by their blood supply.

[2] The surgeon generally chooses the least complex type that will achieve the desired effect via a concept known as the reconstructive ladder.

As with most surgeries, people who are sicker may have more difficulties with wound healing, which include individuals with comorbidities such as diabetes, smoking, immunosuppression, and vascular disease.

[15][16] The risks of flap surgery include infection, wound breakdown, fluid accumulation, bleeding, damage to nearby structures, and scarring.

[20][17] In the 15th century, Gaspare Tagliacozzi, an Italian surgeon, helped develop the "Italian method" for nasal reconstruction, a delayed pedicle skin graft, where the skin from the arm would be attached to the nose for many months to create the reconstruction, first printed in the 1597 book De Curtorum Chirurgia per Insitionem.

[22] Major advancements in modern plastic surgery are mostly attributed to Harold Gillies, who pioneered facial reconstruction during World War I using pedicled tube flaps on patients like Walter Yeo, and the development of the walking-stalk skin flap by Gilles' cousin Archibald McIndoe in 1930.

With the introduction of the operating microscope, microvascular surgery advancements allowed for the anastomosis of blood vessels.