Prelaminating the fascial radial forearm flap by using tissue-engineered mucosa: Improvement of donor and recipient sites

In reconstructive surgery, prelamination of free flaps using split-thicknes s skin is an established technique to avoid the creation of a considerable defect at the donor site, for example, in the case of a radial forearm flap . For oral and maxillofacial surgery, this technique is less than optimal f or the recipient site because the transferred skin is inadequate to form a lining in the oral cavity. To create mucosa-lined free flaps, prelamination using pieces of split-thickness mucosa has been performed. However, the av ailability of donor sites for harvesting mucosa is limited. The present stu dy combines a tissue-engineering technique with free flap surgery to create mucosa-lined flaps with the intention of improving the tissue quality at t he recipient site and decreasing donor-site morbidity. On five patients und ergoing resection of squamous cell carcinoma of the oral cavity, the radial forearm flap was prelaminated with a tissue-engineered mucosa graft to rec onstruct intraoral defects. Using 10 X 5 min biopsies of healthy mucosa, ke ratinocytes were cultured for 12 days and seeded onto collagen membranes (4 .5 X 9 cm). After 3 days, the mucosal keratinocyte collagen membrane was im planted subcutaneously at the left or right lower forearm to prelaminate th e fascial radial forearm flap. One week later, resection of the squamous ce ll carcinoma was performed, and the free fascial radial forearm flap prelam inated with tissue-engineered mucosa was transplanted into the defect and w as microvascularly anastomosed. Resection defects up to a size of 5 X 8 cm were covered. In four patients, the graft healed without complications. In one patient, an abscess developed in the resection cavity without jeopardiz ing the flap. During the postoperative healing period, the membrane detache d and a vulnerable pale-pink, glassy hyperproliferative wound surface was o bserved, This surface developed into normal-appearing healthy mucosa after 3 to 4 weeks. In the postoperative follow-up period, such functions as mout h opening and closing and speech attested to the success of the tissue-engi neering technique for flap prelamination.