A flap is a layer of tissue that is separated from its underlying connections, and its circulation and nerve supply. It is raised so that work can be done underneath, and it is laid back down on the surface for healing. It is like laying sod in your yard. If you don't prepare the underlying bed properly...or if you lay it (ie.) in the driveway where it can't be nourished and encouraged to grow, then it will die.

In a neck dissection, the skin of the neck is lifted from the underlying tissue and folded back. Then the surgeon works at dissecting the underlying tissues, getting out all of the lymph nodes that he can see. Most of them are along predictable pathways, though some might be hidden. This requires some "digging around." It also requires very careful identification of structures, such as blood vessels and important nerves. He can't just dive in and start cutting. It is a pretty slow process. when he has gotten all of the nodes out that he can find, and is satisfied that he hasn't cut something important, he lays the skin flap back down (and of course I don't know the procedure or the preparation) and stitches, glues, or staples the edges shut. Usually there is a drain placed, since the tissues will "weep" inside...serous fluid...and if this fluid is allowed to collect inside the area, it will provide a perfect medium for infection, and it will also possibly keep the skin layer from making good contact with the underlying tissues, thus causing tissue death......ie. death of the flap. That would then require removal of that skin, and a skin graft to cover that area.

This is why you should not begin any sort of massage of your neck until your doctor gives you the go-ahead. But there is a lot of healing that needs to go on inside and outside your neck, and that makes for a lot of potential stiffness from scar tissue.

Is this more than you wanted to know? probably!

XO