Flap prefabrication in the head and neck: A 10-year experience

Tissue neovascularized by implanting a vascular pedicle can be transferred as a "prefabricated flap" based on the blood now through the implanted pedi cle. This technique potentially allows any defined tissue volume to be tran sferred to any specified recipient site, greatly expanding the armamentariu m of reconstructive options. During the past 10 years, 17 flaps were prefab ricated and 15 flaps were transferred successfully in 12 patients. Tissue e xpanders were used as an aid in 11 flaps. Seven flaps were prefabricated at a distant site and later transferred using microsurgical techniques. Tell flaps were prefabricated near the recipient site by either transposition of a local vascular pedicle or the microvascular transfer of a distant vascul ar pedicle. The prefabricated flaps were subsequently transferred as island pedicle naps. These local vascular pedicles can be re-used to transfer add itional neovascularized tissues. Common pedicles used for neovascularizatio n included the descending branch of the lateral femoral circumflex, superfi cial temporal, radial, and thoracodorsal pedicles. Most flaps developed tra nsient venous congestion that resolved in 36 to 48 hours. Venous congestion could be reduced by incorporating a native superficial vein into the desig n of the flap or by extending the prefabrication time from 6 weeks to sever al months. Placing a Gore-Tex sleeve around the proximal pedicle allowed fo r much easier pedicle dissection at the time of transfer. Prefabricated fla ps allow the transfer of moderate-sized units of thin tissue to recipient s ites throughout the body. They have been particularly useful in patients re covering from extensive burn injury on whom thin donor sites are limited.