Omental Transplantation for limb salvage in Buerger’s disease - a study in a tertiary care hospital, Bhopal

Abstract

Introduction: In recent years, it has become evident that peripheral vascular disease is an important predictor of substantial coronary and cerebral vascular risk. The majority of patients present with an advanced stage of ischemia; hence, most of them require surgical intervention in the form of lumbar Sympathectomy, Omentopexy, or major or minor amputations. Patients presenting with terminal limb ischemia due to thromboangitis obliterans often have no hope for limb salvage; for such cases, omental transplantation offers a procedure which can result in improved limb circulation and limb salvage. Objective: To study the efficacy of Omental transplantation in peripheral vascular disease. Material and Methods: This is a prospective study done on a group of 25 patients. The patients were seen in surgical outdoor in emergency and routine hours and were diagnosed on the basis of history, clinical examination and investigations like Colour doppler and femoral arteriography in few cases. Omentopexy was done and patients were assessed on 7th post operative day, after 1 month and 3 months after the procedure. Results: On an average the patients smoked between 10- 25 beedis per day. Amongst these cases 10 cases had non-healing ulcers and 15 had dry gangrene of toes or forefoot, with rest pain. In 15 cases, popliteal artery pulsation was absent. After operative procedure intermittent claudication was relieved in 20 patients (80%). Rest pain was relieved in all the patients at the end of 3 months (100%). Healing of ulcer occurred in 9 out of 10 patients (90%). The healing of amputated toe site occurred in 10 out of 15 patients during 3 months follow-up (66.67%). Conclusion: Buerger’s disease is limb threatening condition occurring in productive age group and its management is challenging. If carried out with right technique and knowledge about vascular omental arcade, the results of omentopexy are good and this technique can help us avoid amputations.