Prefabrication in Microsurgery

Prefabrication is a reconstructive technique that establishes new vascular supply to tissue by transferring a vascular pedicle, making it especially valuable in complex cases with limited donor sites. The process occurs in 2 stages: first, the pedicle is implanted into target tissue to promote angiogenesis and arteriogenesis and second, after 4 to 8 weeks, the flap is elevated on its new blood supply. Prefabrication differs from prelamination, as it adds vasculature rather than layering tissues. Applications extend to skin, cartilage, bone, jejunum, capsules, and even synthetic matrices, though challenges like venous congestion may require additional surgical strategies.