Prefabrication of bilaminar-epithelialized composite flap with tissue expander and cultured keratinocytes

This study investigated the feasibility of prefabrication of a bilaminar-ep ithelialized flap by using a tissue expander and cultured keratinocytes, fo r reconstruction of perforate defects in the oral cavity and upper aerodige stive tract. In each of six rats, a 10-ml volume expander was implanted und er the inferior epigastric flap and a thin silicon catheter was introduced into periexpander space. Seven days after implantation, 10 x 10(6) cultured keratinocytes, isolated from inbred donor rats, were suspended in fibrin g lue and injected into the periexpander space through the catheter (n = 4 of 6). The expansion was started immediately after cell inoculation and laste d at least 3 weeks at the speed of 2 to 3 ml every 5 to 7 days. At the end of expansion, the periexpander space was opened and the capsule around the tissue expander was found to be covered completely with a neoepithelium. Th us. a bilaminar-epithelialized flap based on femoral vessels was elevated a nd successfully transferred to cover the excisional perforate defect in the oral cavity with the neoepithelial side as inner lining. All flaps treated with 10 x 10(6) cultured keratinocytes survived with complete wound healin g during a 1-week follow-up (n = 4 of 6). Both macroscopic and histologic f indings demonstrated that a bilaminar-epithelialized composite flap can be fabricated bu using a tissue expander and keratinocyte-fibrin glue suspensi on.