Tan B K, Chen H C, He T M, Song I C
Department of Plastic Surgery, Singapore General Hospital, Singapore.
Ann Acad Med Singap. 2004 Sep;33(5):662-6.
Flap prefabrication is one of the most exciting areas in Plastic Surgery because of its bridging role between conventional reconstructive surgery and tissue engineering. Using this technique,tissues such as bone, cartilage, skin and muscle can be preassembled to form precise composites that will fit any defect. In pre-lamination, for example, an ear may be created by burying cartilage underneath forearm skin and later harvested as a skin-cartilage composite free flap to replace the missing part. Vascular induction is yet another means of customising flaps where new blood supply is introduced to create transplantable tissue. For example, bone chips wrapped in avascular carrier such as muscle can become vascularised grafts. Our experiment describes jejunal prefabrication in a rat model using the same technique. Intestinal segments wrapped in muscle flaps become independent of their mesenteric blood supply by "parasitising" on the muscle's blood supply. This idea arose from our initial observations that intestinal segments transferred to the neck to reconstruct the oesophagus could survive accidental disruption of the pedicle if sufficient time had elapsed. Clearly, the bowel had picked up new blood supply from its bed. Subsequently, jejunal prefabrication was used to reconstruct the oesophagus in a patient in whom there were no recipient vessels for free jejunal transfer. The pedicled latissimus dorsi muscle flap was used as a carrier for the jejunum. Another application of this idea could be in the area of allogeneic trachea or pancreatic transplantation, since present-day techniques have yet to overcome problems such as insufficient vascularity and unpredictable transplant survival. Future applications incorporating biomaterials and cultured cells will usher in the era of tissue-engineered flaps.
皮瓣预制是整形外科中最令人兴奋的领域之一，因为它在传统重建手术和组织工程之间起到了桥梁作用。使用这种技术，可以预先组装骨骼、软骨、皮肤和肌肉等组织，以形成适合任何缺损的精确复合材料。例如，在预分层过程中，可以通过将软骨埋在前臂皮肤下方来构建耳朵，随后将其作为游离的皮肤 - 软骨复合皮瓣进行采集，以替代缺失的部分。血管诱导是定制皮瓣的另一种方法，即引入新的血液供应以创建可移植组织。例如，包裹在无血管载体（如肌肉）中的骨碎片可以成为血管化移植物。我们的实验描述了在大鼠模型中使用相同技术进行空肠预制。包裹在肌瓣中的肠段通过“寄生”于肌肉的血液供应而独立于其肠系膜血液供应。这个想法源于我们最初的观察，即转移到颈部重建食管的肠段如果经过足够长的时间，在蒂意外中断的情况下仍能存活。显然，肠道从其床获得了新的血液供应。随后，空肠预制被用于一名没有接受游离空肠转移的受区血管的患者的食管重建。带蒂背阔肌肌瓣被用作空肠的载体。这个想法的另一个应用可能在同种异体气管或胰腺移植领域，因为目前的技术尚未克服诸如血管不足和移植存活不可预测等问题。未来结合生物材料和培养细胞的应用将迎来组织工程皮瓣的时代。
