title: [The preconditioning and prelamination of pedicled and free microvascular anastomised flaps with the technique of vacuum assisted closure].
abstract: BACKGROUND
  Since the technique of vacuum assisted closure has been clinically introduced, the possibilities in reconstructive head and neck surgery have greatly increased. Preconditioning and prelaminating allows a pedicled or free flap plasty to be epithelialized on both sides before the flap gets transferred to its future location.
  
  
  METHODS
  We describe the technique of preconditioning and prelaminating of pedicled and free microvascular anastomised flap plasties and we report our experience with 5 cases. Our results are compared with data from the literature.
  
  
  RESULTS
  The procedures concerned take only little time and the flap gets optimally prepared for its task in view of the postoperatively modified hemodynamics. By preconditioning, the flap to be lifted is prepared for the future centralised blood supply exclusively via the pedicle vessel without leaving the donor side. Thereby the skin island of such flaps can be increased in size over the natural angiosomes without an increased risk of necrotisation.
  
  
  CONCLUSIONS
  By the technique of prelamination, skin or mucosa tissue may be applied onto both sides of the flap so that it can resist the biochemical and mechanical tasks which will be required after transposition. Especially for the reconstruction of defects in the upper aerodigestive tract this is a great advantage, since the inner side of the flap has to resist saliva which represents one of the most aggressive secretions in the human body.
authors.affiliation: Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde und Poliklinik, Universitätsklinikum Freiburg. schipper@hno.ukl.uni-freiburg.de
authors.forename: J
authors.initials: J
authors.lastname: Schipper
authors.forename: G J
authors.initials: GJ
authors.lastname: Ridder
authors.forename: W
authors.initials: W
authors.lastname: Maier
authors.forename: R E
authors.initials: RE
authors.lastname: Horch
mesh_terms: D000328:Adult; D001274:Atmospheric Pressure; D005260:Female; D006097:Granulation Tissue; D006801:Humans; D007830:Larynx / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000601:surgery; D013524:Surgical Flaps; D013997:Time Factors; D014138:Tracheoesophageal Fistula / Q000601:surgery; D014945:Wound Healing