Prelamination of the radial forearm flap using tissue engineered mucosa

For primary reconstruction of intraoral defects after tumorresection the microvascular anastomosed the radial forearm flap is a very reliable method. Disadvantages are the additional split-thickness skin grafting from the upper thigh for covering the harvesting defect at the foreram, the risk of complications of exposed tendons, and the limited adaption of skin and hairs especially in men to the mucosa of the oral cavity. To overcome these disadvantages we developed the tissue engineered prelamination of the radial forearm flap. At the time of clinical diagnosis, when the taking the biopsy for pathologic confirmation, an additional biopsy from healthy mucosa is gained for tissue engineering. Within 14 days in a graft is cultured consisting of a mucosa epithelium on a membrane. 7 days before tumor resection this mucosa membrane is implanted in a subcutaneous pocket at the lower arm in local anesthesia. When reconstructing after tumor resection the vessel pedicle and the connective and muscle tissue of the lower forearm flap covered by the tissue engineered mucosa is harvested extending the primary incision proximally. The harvesting defect at the lower forearm is covered primarily by the skinflaps. The tissue engineered mucosa radial forearm flaps showed uneventful intraoral healing and a differentiation of the flap surface into oral mucosa. The harvesting defect at the lower arm healed without complication. This technique reduces the morbidity at the graft harvesting site as well as it improves considerably the soft tissue situation in the oral cavity, producing new perspectives for intraoral reconstruction techniques. Keywords: radial forearm flap, tissue engineering