Omental Transposition Flap Research Articles

Omental transplantation improves surgical outcome of large squamous cell carcinoma: A case report.

Cutaneous squamous cell carcinoma (SCC) is an major health issue due to the significant health costs and marked disfigurement following surgical excision. The conventional reconstructive options may not be suitable for patients with large SCCs of the lower part of the leg, due to the regional tissue damage and ischemic environment. The omental transposition flap is a highly vascularized tissue that is resistant to infection and provides a recipient bed for skin grafts. This is the case report of a male patient with a large SCC in the lower part of his right leg, which was treated with extensive resection. The patient subsequently underwent reconstruction using a free omental flap, followed by transplantation of a secondary skin graft. The patient did not experience recurrence or metastasis during the 2 years of follow-up, indicating that, when dealing with postoperative skin cancer defects in an ischemic environment, omental transplantation may be a viable treatment option.

A difficult case: Omental transposition flap reconstruction of a large radionecrotic axillary ulcer in a patient with extensive previous abdominal surgery

Radionecrotic ulcers due to breast cancer treatment is a highly morbid and disabling condition, causing pain, malodour, need for frequent dressings, reduced range of shoulder movements and an unacceptable cosmetic appearance. In patients with radiotherapy to the chest and/or axilla and general poor health the usual reconstructive options may not be suitable due to regional tissue damage and inappropriate long anaesthetic time, respectively. Described procedures include the pedicled latisimus dorsi flap, transverse rectus abdominal flap (TRAM) and omental transposition flap, as well as free tissue transfer (e.g. free TRAM, DIEP). We report a case of a morbidly obese female patient presenting with a large radionecrotic ulcer in her left axilla, following mastectomy, axillary clearance and local radiotherapy to left chest and axilla for breast cancer. She underwent reconstruction using an omental transposition flap, despite previous abdominal surgery.

Use of a Pedicled Omental Flap in the Treatment of Chest Wall Tuberculosis

The most effective way to treat the chest wall tuberculosis is to fill the residual space with a muscle flap after complete resection of the lesion. However, in some situations a muscle flap cannot be used. The greater omentum has been widely used for reconstruction and the treatment of infections. We describe our technique of using a pedicled omental transposition flap in the management of chest wall tuberculosis for closing the dead space created by excision of the lesion.

Laparoscopic Deroofing Combined with Omental Transposition Flap for Nonparasitic Giant Liver Cyst : A Case Report

Laparoscopic Deroofing Combined with Omental Transposition Flap for Nonparasitic Giant Liver Cyst : A Case Report

Omental Transposition Flap for Sternal Wound Reconstruction in Diabetic Patients

In 2004, we published our 12-year experience with tissue transfer for deep sternal wound infection after median sternotomy, finding increased rates of reoperation for diabetic patients. Therefore, we decided to alter our treatment approach to diabetic patients to include sternal debridement followed by omental transposition. Eleven diabetic patients underwent omental transposition by our division during the study period. Hospital records were retrospectively reviewed to determine outcomes and complications. We found that diabetic patients treated after implementation of the new treatment approach were 5.4 times less likely to require reoperation for sternal wound management than were patients in the previous series, most of whom had been treated with pectoralis muscle flaps (95% confidence interval, 0.5- 50.5). By altering our treatment approach to use omental transposition as the initial surgical therapy, we were able to demonstrate a trend toward decreased need for flap revision in diabetic patients.

Omental Transposition Flap for Salvage of Ventricular Assist Devices

Omental Transposition Flap for Salvage of Ventricular Assist Devices

Anterior Mediastinal Herniation of the Transverse Colon after an Omental Flap Transposition

Poststernotomy mediastinitis continues to be an infrequent but serious complication after cardiac surgery. We present a case of a 59-year-old man who developed a deep sternal wound infection after an emergency cardiac surgery. Omental transposition flap was used to cover the sternal defect. Several days later, the patient developed a transverse colon herniation into the anterior mediastinum that required emergency exploration and colon resection. The patient survived after a difficult hospital course. Indications, technical points, and possible complications of using omental flap transposition are discussed.

Omental Transposition Flap for Salvage of Ventricular Assist Devices

The use of ventricular assist devices for patients with end-stage cardiac failure awaiting heart transplantation has become increasingly common. Ventricular assist devices improve the longevity and the quality of life for these patients. In addition, they serve as a bridge to cardiac allograft transplantation until a donor heart is found. However, ventricular assist device-related infections remain a major problem complicating their long-term use. Clinical infection and sepsis can critically threaten these patients with ventricular assist devices. Infection can delay immediate transplantation and potentially require the removal of the device for definitive treatment of the problem. Patients who underwent insertion of a ventricular assist device at the University of Pittsburgh Medical Center were identified through accessing the medical records archives of the hospital. Review of patients' medical records was conducted to obtain patient demographics, preoperative diagnosis and disease state, type of ventricular assist device inserted, postoperative day of ventricular assist device infection onset, infectious organism identified, timing of omental flap procedure after the initial insertion, duration of ventricular assist device support before cardiac transplantation, and patient follow-up. There were 76 patients who underwent a ventricular assist device insertion procedure during the 4-year period between January of 2000 and January of 2004. Of the 76 patients who received a device, 11 (14 percent) had evidence of clinical infection secondary to insertion. Two of these 11 patients died before surgical intervention, four had their devices explanted, and the remaining five underwent omental flap transposition with bilateral pectoralis major advancement flaps in surgically addressing their infections. Of the five patients with infections who received omental transposition flaps, two went on to undergo successful transplantation, two continue to await cardiac allograft transplantation, and one died as a result of an unknown cause. The authors present their experience with five patients who received omental transposition flaps to cover infected ventricular assist device pumps and the associated tubing in large, open sternoabdominal wounds. Treatment included the direct application of an omental transposition flap over the infected device with use of a bilateral pectoralis advancement flap to aid in complete sternal and skin closure of the sternal wound defect. In each of these cases, the use of the omental flap was followed by resolution of the mediastinal infection. In addition, the treatment with an omental flap prevented the removal of infected devices in patients who were otherwise pump dependent during their waiting periods for transplantation. The use of omental transposition flaps can be an effective technique in salvaging infected ventricular assist devices and preserving this valuable device for patients awaiting a cardiac transplant.

Salvage Treatment of an Irradiated, Infected Lumbosacral Wound

A 60-year-old male with lumbosacral multiple myeloma received 5100 cGy of external-beam radiation, thalidomide, and Decadron. He subsequently underwent excision of the epidural tumor, decompressive L4, L5, and S1 laminectomies, and bilateral L4-5 and L5-S1 medial facetectomies. The patient developed osteoradionecrosis, cerebrospinal fluid leak, wound infection, and sepsis. Debridement and bilateral V-Y fasciocutaneous advancement flaps failed. Pedicled omental transposition flap through a Petit triangle tunnel was successfully performed. Omental transposition provides a safe option for salvage treatment of irradiated, infected lumbosacral wounds. The plastic and trophic qualities of the omentum make it an excellent choice to fill poorly vascularized wounds. In addition to its immunologic and neoangiogenic properties, the omentum has a dense lymphatic network with tremendous absorptive potential. Its biologic advantages must be weighed against the need for celiotomy and available local options according to circumstances.

Laparoscopic treatment of nonparasitic cysts of the liver with omental transposition flap.

Between 1991 and November 1994, 18 patients with large, solitary, nonparasitic liver cysts underwent laparoscopic deroofing; the last 13 of them also received an omental transposition flap in addition. Using three to four trocars, the cystic contents were first aspirated, and the cyst derooted widely using diathermia. An omental transposition flap was fashioned and stapled into the cyst cavity itself. Postoperative complications included one case of pulmonary atelectasis. Another patient developed a subhepatic bile collection which was aspirated percutaneously. On average, patients were discharged on the 4th (2-14) postoperative day. Follow-up was performed with abdominal ultrasound for 2-43 months (mean 19 months). There were two early cyst recurrences, both in cases without an omental transposition flap (overall recurrence rate, 11%; in patients with omental flap, 0). Deroofing in combination with an omental transposition flap is a safe and effective therapy for symptomatic solitary liver cysts and can be performed using minimal-access surgical techniques.

Omental transposition flap for gross locally recurrent breast cancer.

The omentum has been employed to cover the defect produced after resection of gross breast cancer recurrence for nearly three decades. A series of 11 patients undergoing omental transposition flap for very wide resection of gross local recurrence (LR) of breast cancer is reported. The median age was 39 years, with a short interval (median = 21 months) from the treatment of the primary tumour to LR. Local recurrence was gross and predominantly inflammatory. All except one patient had lymphovascular invasion in the recurrent tumour. The omental graft was 100% viable but one patient required re-application of further split-thickness skin graft. The mean hospital stay was 16 days. Two cases of seroma formation were encountered. New recurrence developed around the periphery of the flap in eight patients after a median duration of local control of only 2.5 months. Eight patients died with metastatic disease after a median period of 6 months, six patients with uncontrolled local disease. Five patients were free from LR in over half of their remaining period of life. Omentoplasty is a safe and reliable procedure but the length of palliation achieved is often far from satisfactory.

Lee, S. H., et al. Omental transposition flap and split skin graft for locally advanced breast carcinoma

Lee, S. H., et al. Omental transposition flap and split skin graft for locally advanced breast carcinoma

SURGICAL TREATMENT FOR PATIENTS WITH POST-IRRADIATION ULCER OF THE CHEST WALL

A variety of resection with reconstruction procedures was studied in postirradiation ulcer on the chest wall after mastectomy. Subjects were 7 patients who had post-irradiation ulcers on the chest wall associated with intractable infections or fistulas. The patients were treated surgically, and various degree of chest wall defects were safely repaired with local flap, omental transposition and myocutameous flap. Post-surgical results were satisfactory, and the quality of life was remarkably improved in all cases. However, minor complications such as wound infection and fistula were frequently encountered.Once postirradiation ulcer is infected, it is liable to be intractable or can progress rapidly, in that early surgical resection of the affected chest wall, if possible, is believed to be potentially curative. As to the reconstruction, myocutaneous flap was efficiant, and a use of any kinds of artificial prostheses should be avoided.

Repair of infected defects of the chest wall by transposition of greater omentum

SummaryMyocutaneous flaps have a firm role in the reconstruction of soft tissue defects.1 Furthermore the supply of extremely infected defects of the chest wall with involvement of the ribs is problematic, especially in irradiated regions. The use of the omental transposition flap is an alternative to the latissimus dorsi myocutaneous flap in treatment of such a deficiency associated with necrosis of the ribs and uncovered pleura.2,3 The authors have used this method successfully on eight patients. The scope of this technique is not confined to the chest wall. It can also be extended to defects of the region of the axilla and other parts of the body. For checking the extension and constitution of the greater omentum pre‐operatively a laparoscopy under local anaesthesia is always carried out. All patients seen by the authors experienced primary healing of the omentum and chest wall.

Omental transposition flap in colorectal carcinoma: Adjunctive use in prevention and treatment of radiation complications

The versatility of the omentum has led to its use as a surgical adjunct in the total oncological management of primary and recurrent colorectal carcinoma. The omentum is used as a transposition pedicle flap, broadly based on the left gastroepiploic vascular supply. Following abdominoperineal resection or low anterior resection of the rectum, the small bowel is elevated out of the pelvis by the omental bulk. The pelvic defect is reperitonealized and the risk of pelvic small bowel adhesions is diminished. With the increasing use of postoperative radiation to the pelvis for rectal carcinoma, the tolerance to therapy may be improved and the incidence of radiation enteritis and enteropathy should be reduced. Surgical complications such as leakage from low anterior anastomoses and pelvic abscesses, which may delay or contraindicate necessary postoperative radiation, are dramatically decreased. Reconstruction of the perineum with omental flap provides adequate soft tissue bulk and contour when a radical resection has been performed. The omentum has the potential for neovascular proliferation and can act to prevent inastomotic dehiscence of intestinal anastomoses involving previously irradiated bowel. Furthermore, covering unresectable recurrent carcinoma in the pelvis and retroperitoneum with the omentum as a palliative measure provides a thick anatomical barrier against potential ureteral, bladder, and small bowel invasion and obstruction. The omental flap has been used in 24 patients with colorectal carcinoma; one flap was lost as a result of distal omental infarction in a patient with recurrent rectal carcinoma and radionecrosis of the perinemn. The safety and ease of this procedure has allowed increased surgical innovation, especially in the prevention and treatment of radiation complications.

Omental transposition flap in colorectal carcinoma: Adjunctive use in prevention and treatment of radiation complications

Omental transposition flap in colorectal carcinoma: Adjunctive use in prevention and treatment of radiation complications