• Archives of Reconstructive Microsurgery
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• 제11권2호
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• pp.125-134
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• 2002

This study was designed to investigate the process of re- or neo-vascularization in the prefabricated cutaneous flap using a skeletonized arteriovenous pedicle implantation. Fourty-eight flaps were divided into six groups of eight flaps, including control group of the conventional epigastric flap. In experimental groups, skin flap was fabricated by subcutaneous implantation of a distally ligated saphenous arteriovenous pedicle in left abdomen. At 2, 4, 6, 8, and 10 weeks after, prefabricated flap was elevated as an island flap based on implanted pedicle and sutured back in place. Three days after flap repositioning, the area of flap viability was quantified, the pattern of flap vascularization was evaluated with microangiography, and the quantification of vessels was assessed histologically. There were statistically significant differences in flap viability between group 2, 3, 4, and the control (p<0.05), with increased survival area in order. But Group 5 and 6 showed higher flap viability as much as the control did. In the microangiographis study, numerous small meander vessels were newly developed in the vicinity of the implanted pedicle just only 2 weeks after pedicle implantation, but neovascularization around the tip of implanted pedicle, and its anastomosis with native vasculatures was more important for overall flap survival, which was usually developed at least 4 weeks after pedicle implantation. Histologically, vessels are evenly spread over all layers of the flap at 6 weeks after pedicle implantation. The quantification of vessels was correlated well with the improvement of flap viability (p<0.05). In conclusion, neo- and re-vascularization around the tip of implanted pedicle was an important factor for overall survival of the prefabricated flap. Therefore, skeletonized pure vascular pedicle transfer, even though it used alone without surrounding was sufficient to get higher flap viability. The optimal duration of pedicle implantation was8 weeks to obtain maximal survival.

• Archives of Plastic Surgery
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• 제32권3호
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• pp.327-334
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• 2005

This study was designed to investigate the effect of the surgical delay in the prefabricated cutaneous flap. Abdominal skin flaps (n=40), $4.5{\times}6.0cm$ in size, were created by the subcutaneous implantation of a saphenous vascular tissue in the male Sprague-Dawley rats. In the groups 1 and 2, the pedicle was skeletonized. In the groups 3 and 4, perivascular muscle cuff or gracilis fascia was retained, respectively. Six weeks later, each flap was elevated as an island flap and reposed in place. All flaps of the group 2 had a 72-hours of delay period. Five days after the flap repositioning, estimation of flap viability, microangiographies, and histological evaluation of vessel development were performed. The groups 2 and 3 showed higher viability in flap survival. The dilated choke vessels and fully developed vascular network were observed in the flap of the group 2, but not typically seen in the other groups. New vessels around the implanted pedicle were more developed in the group 2. Amount of the vessels in the mid-portion of the flap was significantly increased in the groups 2 and 4. In conclusion, the delay procedure enhanced the viability, and its effect was dependent on the new vessel formation around the implanted pedicle.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제30권4호
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• pp.301-307
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• 2004

The flap considered at first for the reconstruction of large maxillary defect, especially mid-face defect, is scapular free flap, because it provides ample composite tissue which can be designed 3-dimensionally for orbital, facial and oral reconstruction. In case of maxillary defect involving hard palate, however, this flap has some limitations. First, its bulk prevents oral function and physio-anatomic reconstruction of nasal and oral cavity. Second, mobility and thickness of cutaneous paddle covering the alveolar area reduce retention of tissue-supported denture and give rise to peri-implantitis when implant is installed. Third, lateral border of scapula that is to reconstruct maxillary arch and hold implants is straight, not U-shaped maxillary arch form. To overcome these problems, new concept of step prefabrication technique was provided to a 27-year-old male patient who had been suffering from a complete hard palate and maxillary alveolar ridge defect. In the first stage, scapular osteomuscular flap was elevated, tailored to fit the maxillary defect, particulated autologous bone was placed subperiosteally to simulate U-shaped alveolar process, and then wrapped up with split thickness skin graft(STSG, 0.3mm thickness). Two months later, thus prefabricated new flap was elevated and microtransferred to the palato-maxillary defect. After 6 months, 10 implant fixtures were installed along the reconstructed maxillary alveolus, with following final prosthetic rehabilitation. The procedure was very successful and patient is enjoying normal rigid diet and speech.