Clinical applications and technical limitations of prefabricated flaps.

Vascular pedicle implantation into the subdermal level of the skin induces an angiogenic response that can be sufficient to artificially create or "prefabricate" an axial-pattern flap suitable for island pedicle or free-flap transfer. This technique allows the creation of large, thin skin flaps that retain the qualities of the donor-site skin. Three cases are presented in which such thin flaps have been created to cover defects, one on the knee and two on the face. While the reconstructions are satisfactory, difficulties were encountered with venous insufficiency in the flaps after the second-stage transfer. We believe that the complexity and staged nature of these procedures limit their application to highly selected patients, but their role probably lies in the transfer of supraclavicular skin for the reconstruction of facial defects.