Prefabrication as a Term in Flap Surgery: Do We Need a Broader Definition?

Prefabrication is an important term of flap surgery. Yet for many years, we do not know it accurately, not to mention its proper use in academic papers.

Tracing back history, prefabrication first appears in the record of house-building. According to Wikipedia, it initially means the practice of assembling components of a structure elsewhere, and then transporting the assemblies to the site of construction. Later, its meaning expands to include the manufacture of ships, aircraft, and all kinds of vehicles and machines.

It became a surgical term in 1982, when Shen coined prefabricate to describe his prevascularized thigh flap.[1] Since then, it has been used by many authors of flap techniques, yet in an unstandardized manner. For example, prefabrication is sometimes used interchangeably with prelamination, another term frequently used in complex reconstruction. To avoid the confusions, Guo and Pribaz tried to define prefabrication as a two-stage process in 2009: implantation of a vascular pedicle to the donor tissue and a secondary transfer of the neovascularized tissue to the recipient area.[2] Through this he faithfully transmitted Shen's original meaning of introduction of axial blood supply. In the same article, he defined prelamination as follows: engrafting of one or more tissues into a reliable vascular bed and a subsequent transfer on its original vascular supply en bloc to the defect site.[2] Clearly, the lather definition stresses the making of a multitissue structure.

But the term seems to have wider usage in the literature. For instances, Sonmez based his prefabrication on the sciatic nerve,[3] and Chen prefabricated a bone flap by demineralized bone matrix (DBM) with a vascular loop.[4] In a more complicated case, we prefabricated a cervicothoracic skin flap by implantation of a lateral thigh fascial flap and tissue expander.[5] One possible reason might be that the term literally means “fabrication beforehand.”

To resolve the confusion, we suggest that the term be redefined in a broader sense. Typically, a good definition combines the following three elements: literal meaning, history of use, and space for possible evolution. In this regard, prefabrication shall include, but not be limited to, the introduction of vasculature, or even augmentation of blood flow. Instead, it might refer to any reconstructive procedure involving early-stage efforts to improve flap quality and modify flap structure. If so, the new concept of prefabrication will contain both prevascularization and prelamination, and leave space for other emerging techniques.

• References

• 1 Shen ZY. Microvascular transplantation of prefabricated free thigh flap. [letter] Plast Reconstr Surg 1982; 69 (3) 568
• 2 Guo LF, Pribaz JJ. Prefabrication and prelamination of flaps. In: Wei FC, Mardini S. Flaps and reconstructive surgery. Philadelphia: Saunders; 2009: 103-116
• 3 Sonmez E, Cengiz Bayram F, Safak T. A new flap prefabrication model: prefabricated neural-island flap. Ann Plast Surg 2011; 66 (4) 364-369
• 4 Chen WJ, Zhang F, Mustain WC, Tucci M, Hu EC, Lineaweaver WC. Prefabrication of vascularized bone flap by demineralized bone matrix. J Craniofac Surg 2007; 18 (1) 43-48
• 5 Li Q, Zan T, Gu B , et al. Face resurfacing using a cervicothoracic skin flap prefabricated by lateral thigh fascial flap and tissue expander. Microsurgery 2009; 29 (7) 515-523