Fr. Carls et al., PREFABRICATION OF MUCOSA-LINED FLAPS - A PRELIMINARY-STUDY IN THE PIGMODEL, Plastic and reconstructive surgery, 101(4), 1998, pp. 1022-1028
There is a need in reconstructive surgery for flaps lined by nonkerati
zing stratified squamous epithelium or mucous membrane. Applications c
ould be found in nasal, oral, genital, and esophageal reconstruction a
nd even in reconstruction of hollow intra-abdominal tubes. Prefabricat
ion of lined flaps has so far been limited to a pretransfer grafting o
f split-thickness skin. However, in certain situations this does not s
atisfy the primary requirement of replacing ''like with like.'' Also,
the availability of donor sites for harvesting mucosa is limited. The
present study involves prefabrication of mucosa-lined flaps without ca
using donor site morbidity. The study was carried out on six mini-Hart
ford pigs. Buccal mucosa was harvested from the cheeks; the sheet was
divided into several smaller graft pieces of 1 to 2 cm(2) area. These
graft pieces were then applied to the deep fascia at a distance of 5 t
o 15 mm from one another, also to galea, and to the undersurface of sk
in flaps. The grafted area was isolated from the opposing surface with
a silicone sheet or Marlex mesh. The grafts were allowed to take and,
it was hoped, merge together to form a sheet graft of dimensions grea
ter than those of the original. Two to 7 weeks after the initial graft
ing, the skin flap was elevated; the mucosal grafts were observed macr
oscopically for take and surface area and microscopically to confirm t
hat the lining was indeed mucosa. The mucosa took well on both the fas
cia and galea and also on the undersurface of the skin; it enlarged in
size, and the small pieces became confluent to form a single sheet. T
he increase in surface area varied from 33 percent at 11 days postgraf
ting to a maximum of 238 percent after 7 weeks. All pigs had positive
cultures from the mucosa before implantation but only one developed gr
oss infection leading to partial graft loss.