Skin flap prefabrication using acellular dermal matrix and cultured keratinocytes in a porcine model

In an effort to minimize the amount of autogenous tissue that is sacrificed in using a random skin flap, the authors, in a porcine model, implanted 3. 0 x 7.0-cm (median thickness, 1 mm) sheets of commercially available nonmes hed acellular dermal matrix (AlloDerm) subcutaneously. After a vascularizat ion period of 2 weeks, the implants were elevated and used as turnover derm al flaps to cover adjacent 3.0 x 3.0-cm full-thickness skin defects. Sheets of autogenous cultured keratinocytes were used for epithelium. The AlloDer m-cultured keratinocyte complex flaps healed without any complications. Mea surements for percent contraction of the wound to determine the suitability of AlloDerm as a dermal flap showed that the wounds had contracted an aver age of 18 +/- 3.6% at 24 weeks. Histological evaluation revealed multilayer ed keratinocytes and indurations between the cultured keratinocytes and All oDerm. Fibroblast infiltration and the presence of luminal spaces surrounde d by capillary endothelium characteristic of neovascularization of the matr ix were also noted. This preliminary study may form the basis for developin g other types of prefabricated flaps using AlloDerm and cultured keratinocy tes.