[Tissue-engineered cartilage in a prefabricated microvascularized flap]

HNO. 2004 Jun;52(6):510-7. doi: 10.1007/s00106-003-0932-9.
[Article in German]


Introduction: In reconstructive surgery, the integration of tissue-engineered cartilage in a prefabricated free flap may make it possible to generate flaps combining a variety of tissue components to meet the special requirements of a particular defect. The aim of the present study was to establish the technique of prefabricating a microvascular free flap by implanting a vessel loop under a skin flap in a rabbit model. The second aim was to gather experience with prelaminating the flap with autologous tissue-engineered cartilage in terms of matrix development, inflammatory reaction and host-tissue interaction.

Methods: The microvascular flap was created by implanting a vessel loop under a random pattern abdominal skin flap. The tissue-engineered cartilage constructs were made by isolating chondrocytes from auricular biopsies. Following a period of amplification, the cells were seeded onto a non-woven scaffold made of a hyaluronic acid derivative and cultivated for 2-3 weeks. One cell-biomaterial construct was placed beneath the prefabricated flap, and the others were placed subcutaneously under the abdominal skin and intermuscularly at the lower extremity. In addition, a biomaterial sample without cells was placed subcutaneously as a control. All implanted specimens were left in position for 6 or 12 weeks. After explantation, the specimens were examined by histological and immunohistological methods. The prefabricated flap was analyzed by angiography.

Results: The prefabricated flaps showed a well-developed network of blood vessels formed by neovascularization between the implanted vessel loop and the original random-pattern blood supply. The tissue-engineered constructs remained stable in size and showed signs of tissue similar to hyaline cartilage, as evidenced by the expression of cartilage-specific collagen type II and proteoglycans. No hints of inflammatory reactions were observed.

Conclusion: These results show the potential of prefabricated flaps as custom-made flaps for reconstructive surgery in difficult circumstances, more or less independent of anatomical prerequisites. Cartilage tissue engineering provides a 3-dimensional structure with minimal donor-site morbidity.

Publication types

  • Evaluation Study

MeSH terms

  • Animals
  • Cartilage / growth & development*
  • Cartilage / pathology
  • Cartilage / transplantation*
  • Cell Culture Techniques / methods
  • Foreign-Body Reaction / pathology*
  • Graft Rejection / pathology
  • Plastic Surgery Procedures / methods
  • Rabbits
  • Surgical Flaps / adverse effects
  • Surgical Flaps / pathology*
  • Tissue Engineering / methods*
  • Transplants / adverse effects