Tolerance of prefabricated skin flaps to ischaemia and reperfusion: experimental study

Custom prefabrication of tissues allows the surgeon to build what is required for the reconstruction and has enabled the surgeon to reinforce new blood supply into selected blocks of tissue without vessel anastomosis. However, prefabricated flaps have several drawbacks and characteristics that differentiate them from conventional flaps. The objective of this study was to test the tolerance of prefabricated flaps to ischaemia/reperfusion injury in rats. In the first stage, the unilateral-inferior-epigastric pedicle was ligated and divided, and then a skin flap was fabricated by implantation of distally ligated femoral arteriovenous pedicle beneath the abdominal skin. The femoral vessels were implanted either in skeletonised or in muscle-cuffed fashion beneath the abdominal skin, a portion of which was raised as an island flap, based on these vessels. Prefabricated flaps (3×6 cm) were raised 6 weeks after, and were subjected to 10 h ischaemia and followed by 12 h reperfusion. Flap survival and histological changes at the pedicle-skin junction were evaluated at 7 days. Flap necrosis in the sham group was 0%, whereas the control group (conventional) had 47.27±13.50% necrosis. Flaps prefabricated with skeletonised femoral pedicle demonstrated an insignificant pattern with 63.74±10.62% necrosis when compared with prefabricated flaps with muscle-cuffed pedicle with the percentage of necrosis of 64.51±11.24. The area of necrosis was significantly increased when both the prefabricated flaps were compared with the control group or with the sham-prefabricated group (p<0.05). Skin flaps prefabricated with either pedicle-alone or pedicles with muscle cuff are more susceptible to ischaemia and following reperfusion in comparison with the normal flaps.