During the past 2 decades we have witnessed substantial increases in the capability to reconstruct tissue defects. These advances have resulted from improved understanding of patterns of circulation and improved techniques to design and transfer flaps from one location to the other. Despite these advances, there is often a need for a method of reconstruction that results in more accurate anatomic restoration or a less severe donor-site deformity. Recent efforts have focused on going beyond the constraints imposed by naturally available flaps. Thus, techniques to effectively engineer the desired tissue in vivo and in vitro are emerging.
For tissue engineering in vivo, custom flap prefabrication is used.1 In this method, the donor tissue is selected to meet material needs required for optimum reconstruction. If this tissue does not have a blood supply pattern that permits reliable transfer by standard techniques, an artery and vein pair is transferred to lie