Reconstruction can be challenging in patients with minimal normal tissue who require free tissue transfer. Pre-fabrication of flaps has expanded the options available for reconstruction but still requires healthy, normal donor tissue and a vascular carrier.

We report on a 36 year old male patient who suffered 80% total body surface area full thickness burns and anoxic brain injury. He subsequently developed joint contractures including one of the left elbow resulting in a chronic wound. We planned to release the contracture and cover the wound with an anterolateral thigh free flap; the thigh skin had been used as a skin graft donor site previously. Intraoperatively the venous drainage of the flap was compromised so the flap was left in place, observed on the floor and the contracture left intact.

The flap subsequently failed and was debrided. The pedicle and its venae comitante dissected back to it's origin along with a cuff of muscle distally. The flap donor site and vascular pedicle was covered with Integra and allowed to heal. After this neovascularization took place the Integra was skin grafted and then successfully transferred to the antecubital fossa. This is the first known free transfer of a tissue engineered, pre-fabricated flap.