The myoadipose flap: a new composite

A prefabricated composite fat flap consisting of muscle woven into an anatomically distinct fat pad was studied in a rabbit model. In 17 rabbits, a 2-cm strip of latissimus dorsi was woven into the parascapular fat pad on one side, with the contralateral fat pad serving as a control. At 3 weeks, the endogenous blood supply of both the control and the experimental fat pads was isolated and ligated, and the composite fat/muscle flap was transferred to the chest wall. At 6 weeks, animals were killed, and flaps were analyzed for length, width, and weight; perfused with fluorescein or lead oxide; and examined histologically. Significant differences were found between the control and experimental fat pads with regard to weight and length. Experimental flaps were found to be perfused fully with fluorescein and lead oxide; control fat pads were found not to be perfused. The lead oxide group revealed extensive growth of blood vessels from the latissimus graft into the experimental fat pad. No vessels were visualized in the controls. Finally, sections of the control and experimental flaps were analyzed histologically. A preponderance of viable fat, with evidence of neovascularization, was found in experimental flaps, compared with the necrotic fat that characterized the controls. We conclude that prefabrication of a fat flap is possible and may have extensive application in various areas of plastic surgery.