T.M MacLeod, G Williams, R Sanders, C.J Green 

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Prefabricated skin flaps in a rat model based on a dermal replacement matrix Permacol™  T.M MacLeod, G Williams, R Sanders, C.J Green  British Journal of Plastic Surgery  Volume 56, Issue 8, Pages 775-783 (December 2003) DOI: 10.1016/S0007-1226(03)00383-7

Fig. 1 Diagrammatic representation of the stages of prefabrication: (A) isolation of the superficial epigastric vessels; (B) placement of a polyethylene sheet together with a piece of Permacol™ behind the vessels; (C) placement of a second piece of Permacol™ in front of the vessels (sandwiching the superficial epigastric vessels between them); and (D) isolation of the Permacol™ construct from the surrounding tissues with a second piece of polyethylene sheet. British Journal of Plastic Surgery 2003 56, 775-783DOI: (10.1016/S0007-1226(03)00383-7)

Fig. 2 Process of prefabrication continued: (A) opening of the polyethylene sheet at 2, 4, 6 or 8 weeks; (B) skin graft application to the upper surface of the construct and ligation of the distal part of the vascular pedicle; and (C) the pedicled prefabricated Permacol™ flap. British Journal of Plastic Surgery 2003 56, 775-783DOI: (10.1016/S0007-1226(03)00383-7)

Fig. 3 Macroscopic appearance of fibrous tissue encapsulating the polyethylene enclosed constructs. British Journal of Plastic Surgery 2003 56, 775-783DOI: (10.1016/S0007-1226(03)00383-7)

Fig. 4 Photomicrograph of epigastric artery and vein on the surface of Permacol™ as seen intraoperatively (A) and 2 weeks postoperatively (B). Significant vascular outgrowth is seen from the epigastric pedicle onto inner surface of Permacol™ construct. British Journal of Plastic Surgery 2003 56, 775-783DOI: (10.1016/S0007-1226(03)00383-7)

Fig. 5 Photomicrographs showing the outer surface of a standard Permacol™ construct 4 weeks after implantation of the epigastric pedicle. Blood vessels are seen to pass both (A) around the periphery of the construct and (B) through hair follicle remnants present within the matrix. British Journal of Plastic Surgery 2003 56, 775-783DOI: (10.1016/S0007-1226(03)00383-7)

Fig. 6 Photomicrographs showing the outer surface of a standard Permacol™ construct: (A) 6 weeks after implantation of the vascular pedicle and (B) 1 week after application of a split thickness skin graft to its outer surface. British Journal of Plastic Surgery 2003 56, 775-783DOI: (10.1016/S0007-1226(03)00383-7)

Fig. 7 Chart showing the percentage vascularity of: Laser treated 0.4 mm thickness Permacol™; Laser treated 0.75 mm Permacol™; Standard 0.75 mm thickness Permacol™ constructs; and Standard 1.5 mm thickness Permacol™ constructs 2, 4, 6 and 8 weeks after implantation of the epigastric vascular pedicle within the construct. Results shown are means±standard error of the mean of n=4 constructs at each time point. Laser treated Permacol™ constructs have a significantly greater percentage vascularity vs. standard Permacol™ constructs at all time points studied ***P<0.001. British Journal of Plastic Surgery 2003 56, 775-783DOI: (10.1016/S0007-1226(03)00383-7)

Fig. 8 Photomicrographs of laser treated Permacol™ construct showing: (A) the macroscopic appearance and (B) the microscopic appearance of blood vessels within the laser pores of the matrix. Histological section stained with Masson's trichrome (original magnification ×20). British Journal of Plastic Surgery 2003 56, 775-783DOI: (10.1016/S0007-1226(03)00383-7)