Prefabricated Vascularized Periosteal Grafts Using Fascial Flap Transfers

ABSTRACT

The purpose of this study was to demonstrate the feasibility of prefabricated vascularized periosteal grafts using fascial flap transfers. Fifty rats were divided into two groups (Group A underwent periosteal wrapping, and Group B underwent fascial wrapping). Fascial flaps from the medial leg, which were nourished by the saphenous artery and vein, were used for all grafts. In Group A, the fascia was transferred onto the proximal tibial periosteum. Two weeks postoperatively, the elevated fascioperiosteal flap was wrapped around a 4-mm hydroxyapatite cube. In Group B, the fascial flap was immediately wrapped around the hydroxyapatite cube. In both groups, the hydroxyapatite-wrapped cube was transferred to the inguinal region. Three days postoperatively, five rats from group A were sacrificed. On histologic examination, these five showed no necrosis of the fascioperiosteal flap and no bone formation. The remaining 45 rats were sacrificed 5 weeks postoperatively. Microangiography was performed on five rats in Group A, revealing neovascularization of the hydroxyapatite. On histologic examination, new bone formation was confirmed in 15 of the remaining 20 rats in Group A, and in three of the 20 rats in Group B. These experiments demonstrated that the prefabricated vascularized periosteal graft, which has good osteogenic capacity, could be carried out using a fascial flap transfer.