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The technology of flap prefabrications is a new, powerful tool in plastic and reconstructive surgery. It is based on an old idea, while applying the latest innovations in surgery. It involves any modification of a surgical flap done before its transfer to the final donor site, including surgical delay, pre-expansion, pre-grafting, the use of tissue engineering, biomaterials and perforators surgery, or the creation of a new pedicle by staged transfer of a vascular bundle. The different possibilities are discussed, with special reference to their biologic basis.