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Large Prefabricated Skin Flaps Based on the Venous System in Rabbits: A Preliminary Study

Background: Flap prefabrication offers a bridging role between traditional reconstructive surgery and tissue engineering; however, because flap prefabrication is based on the concept of implanting a nourishing vascular pedicle in the target tissues before transfer, survival remains unreliable. Furthermore, the extended period required for neovascularization hampers its clinical application. Methods: Based on two different venous angiosomes involving two sides of thoracoepigastric veins (taken as the vascular carrier) in rabbits, a large abdominal flap measuring 12 × 13 cm was designed by anastomosing the transferred femoral artery with the thoracoepigastric vein distally and prefabricated by incision of the proximal and distal ends of the flap for 1 week. Traditional arterial flaps, arterialized venous flaps, and composite skin grafts of the same size were used as control groups. Flap viability, status of vascular perfusion and microvasculature, and level of epidermal metabolite in each group were assessed. Results: The large prefabricated flaps achieved results similar to the traditional flaps in terms of flap viability, status of vascular perfusion and microvasculature, and level of epidermal metabolite. Conclusions: Large skin flaps with good quality can be prefabricated within a shorter period for aesthetic and plastic surgery reconstruction using the inherent venous system. This technique may prove to be a viable alternative for successful flap prefabrication.