DURABILITY OF PREFABRICATED VERSUS NORMAL RANDOM FLAPS AGAINST A BACTERIAL CHALLENGE

Numerous reports of flap prefabrication have demonstrated good surviva l. The durability of these flaps compared with that of other flap type s or normal tissue, however, remains unknown. The purpose of this stud y was to determine how prefabricated flaps respond to a bacterial chal lenge compared with identically sized normal random-pattern flaps. Rat abdominal cutaneous-panniculus carnosus flaps were prefabricated with a standard-sized groin fasciovascular tissue carrier and then inocula ted with Staphylococcus aureus. The prefabricated flaps were divided i nto two groups. Group one (standard prefabricated flap, n = 24) receiv ed no growth factor. Group two (n = 24) received an angiogenic growth factor between the carrier and flap tissue. A random-pattern flap serv ed as a nonprefabricated control (n = 12). Grading of the prefabricate d flaps with growth factor versus the standard prefabricated flaps ver sus controls showed dehiscence (41 versus 37 versus 4 percent), ulcera tion (21 versus 29 versus 18 percent), erythema/cellulitis (40 versus 44 versus 8 percent), and necrosis (9 versus 29 versus 0 percent). The control flaps had significantly less dehiscence, erythema/cellulitis, and necrosis than the standard prefabricated flaps. Similarly, the pr efabricated flaps with angiogenic growth factor had significantly less necrosis than the standard prefabricated flaps. Conclusions: (1) pref abricated flaps were demonstrated to be less durable than random-patte rn flaps against a bacterial challenge, (2) angiogenic growth factor m ay help to improve the durability of prefabricated flaps against bacte rial infection, and (3) the biologic behavior of prefabricated flaps i s not the same as that of normal tissue and deserves further investiga tion.