A human-scale porcine fasciocutaneous and muscle flap model for the evaluation of ortho-plastic reconstructions of lower-limb defects

Slater, J; Stilling, M; Krag, AE; Tøstesen, SK; Mikkelsen, MKD; McNally, M; Ramsden, AJ; Jensen, LK; Kiil, BJ; Bue, M

Women's Health Collection

Journal article

A human-scale porcine fasciocutaneous and muscle flap model for the evaluation of ortho-plastic reconstructions of lower-limb defects

Abstract:: Introduction: Fasciocutaneous and muscle flaps are used for the reconstruction of lower-limb composite bone and soft-tissue defects. Flap-mediated contributions to the healing microenvironment are less described. We present a comparative porcine model with a standardized bone and soft-tissue defect reconstructed by fasciocutaneous or muscle flaps and characterize the early tissue response following flap transfer. Methods: Using both hindlimbs of 10 female pigs, symmetrical tibial bone and soft-tissue defects were created and reconstructed with fasciocutaneous flaps ( n= 8) or muscle flaps ( n= 8) or were closed primarily ( n= 4, controls). Interstitial metabolites (glucose, lactate, and pyruvate) were sampled by microdialysis from flap and control tissue for 11 h before, during, and after 60 min of global flap ischemia (simulating free flap transfer). Flap histopathology was graded for the acute inflammatory response. Results: All pigs and flaps completed the study. Both flaps exhibited ischemia-reperfusion-induced metabolic alterations relative to the control tissue. The lactate-to-pyruvate ratio increased 3-fold in muscle flaps during ischemia, while fasciocutaneous flaps showed lactate and a lactate-to-pyruvate ratio that were 1.5-fold higher during reperfusion. Histopathology demonstrated early cellular activity at the bone lesion-flap interface in both flap types, with greater oedema and hyperaemia in fasciocutaneous flaps. Conclusion: We established a reproducible comparative large-animal model integrating interstitial metabolite and histopathological analyses to describe early flap-mediated tissue responses. Early flap-specific differences in metabolic and structural patterns may influence flap function and the healing microenvironment. The model provides a basis for evaluating clinically relevant ortho-plastic outcomes.

Publication status:: Published

Peer review status:: Peer reviewed

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APA Style

Slater, J., Stilling, M., Krag, A. E., Tøstesen, S. K., Mikkelsen, M. K. D., McNally, M., Ramsden, A. J., Jensen, L. K., Kiil, B. J., & Bue, M. (2025). A human-scale porcine fasciocutaneous and muscle flap model for the evaluation of ortho-plastic reconstructions of lower-limb defects. Journal of Bone and Joint Infection, 10(6), 597–607.

MLA Style

Slater, J, et al. “A Human-Scale Porcine Fasciocutaneous and Muscle Flap Model for the Evaluation of Ortho-Plastic Reconstructions of Lower-Limb Defects.” Journal of Bone and Joint Infection, vol. 10, no. 6, 2025, pp. 597–607.

Chicago Style

Slater, J, M Stilling, AE Krag, et al. 2025. “A Human-Scale Porcine Fasciocutaneous and Muscle Flap Model for the Evaluation of Ortho-Plastic Reconstructions of Lower-Limb Defects.” Journal of Bone and Joint Infection 10 (6): 597–607.
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