Techniques and Innovations in Flap Engineering: A Review

Abstract

Background: Currently, the gold standard for complex defect reconstruction is autologous tissue flaps, with vascularized composite allografts as its highest level. Good clinical results are obtained despite considerable obstacles, such as limited donor sites, donor site morbidity, and complex operations. Researchers in the field of tissue engineering are trying to generate novel tissue flaps requiring small or no donor site sacrifice. At the base of existing technologies is the tissue’s potential for regeneration and neovascularization. Methods: A review was conducted identifying relevant published articles in PubMed on the subject of flap engineering, with the focus on plastic surgery. This review article surveys contemporary technologies in flap engineering, including cell sheet technology, prefabricated flaps, and tissue engineering chambers. Conclusions: Some of the described procedures, though not yet ready for clinical use, are certainly ready for trial in large animal models and even human studies. Tissue engineering is a promising field for the handling of large and complex tissue defects.

Prefabrication—a Vascularized Skin Flap Using an Arteriovenous LoopPrefabricated Flap With Arteriovenous Loop

“…In previously reported cases, TSS was treated by surgical excision of the enlarged thyroid gland. [1][2][3][4] However, in our case, bilateral thyroid enlargement was obvious in the patient and the blood-supplying arteries of the thyroid were also significantly enlarged. Hence, surgical removal of the thyroid would have caused hypothyroidism.…”

“…1,2 There are very few reported cases of TSS, primarily caused by goiter, and cerebral angiogram showed an enlarged thyroid artery blood supply, which was possibly due to the development of goiter, leading to more blood flow to the thyroid and a decrease in intracranial blood flow. 2,3 In 2022, Harrison Humphries and colleagues reported the first case of TSS caused by active hyperthyroidism in a patient who did not have high levels of TSH or goiter, but had high levels of thyroid receptor antibodies that mimic the effects of TSH. 2,5 Our patient had a high TSH level, a large goiter, and obvious enlargement of the thyroid artery.…”

“…2,3 In 2022, Harrison Humphries and colleagues reported the first case of TSS caused by active hyperthyroidism in a patient who did not have high levels of TSH or goiter, but had high levels of thyroid receptor antibodies that mimic the effects of TSH. 2,5 Our patient had a high TSH level, a large goiter, and obvious enlargement of the thyroid artery. Therefore, we hypothesized that the patient's repeated cerebellar infarction and uncontrolled hyperthyroidism symptoms were due to TSS.…”

“…Flap prefabrication is a promising solution to this problem. 2 After the implantation of a vascular pedicle and a period of revascularization, prefabrication enables the conversion of a random flap into an axial flap. On the merits, this technique overcomes the restriction of classic anatomic vascular territories and allows plastic surgeons to produce more esthetically pleasing and personalized flaps as needed.…”

“…In clinical practice, it relies mainly on axial flaps,1 but their donor sites are scarce due to a lack of available known vascular pedicles, particularly in the head and neck. Flap prefabrication is a promising solution to this problem 2. After the implantation of a vascular pedicle and a period of revascularization, prefabrication enables the conversion of a random flap into an axial flap.…”