Prefabricated osteomusculocutaneous flaps using calvarial bone: experimental study

Prefabricated osteomusculocutaneous flaps using free calvarial bone were examined and evaluated in a rat model. The animals were divided into two groups according to prefabrication time: 14 days in Group 1 (n = 10) and 28 days in Group 2 (n = 10). Nine of 10 preparations demonstrated neovascularization in Group 1, and all flaps showed neovascularization in Group 2. One flap was lost in Group 1 as a result of infection. Each group was evaluated histopathologically before the second stage of the experiment. Muscles without atrophy and osteocytes were noted in Group 1; however, Group 2 animals had both muscle atrophy and nonviable bone. The prefabricated osteomusculocutaneous flaps were then transferred as both island and free flaps. Flap viability was assessed on postoperative day 7 by macroscopic observation. Although all flaps survived in the island-flap group, two flaps failed to survive due to technical error in the free-flap group. Neovascularization was clearly evident by 2 weeks in the osteomusculocutaneous flaps; after 4 weeks, complete atrophy of the muscle meant that the flaps could no longer be characterized as osteomusculocutaneous. Clinically, it might be possible to use the outer table alone, in which case both thin skin and bone would be desirable. This study may provide a model for this approach.