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Morawska-Kozłowska M, Wilkosz A, Zhalniarovich Y. The Omentum-A Forgotten Structure in Veterinary Surgery in Small Animals' Surgery. Animals (Basel) 2024; 14:1848. [PMID: 38997960 PMCID: PMC11240631 DOI: 10.3390/ani14131848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/16/2024] [Accepted: 06/17/2024] [Indexed: 07/14/2024] Open
Abstract
The greater and lesser omentum are derived from embryonic mesogastrium. The expansive greater omentum in dogs covers intestinal coils, while in cats, it is smaller. Comprising distinct portions, the greater omentum is rich in lymphatics and blood vessels. Conversely, the lesser omentum spans the liver, stomach, and duodenum. Studies on canine omentum reveal unique immune cell composition and regenerative potential attributed to adipose tissue-derived stromal cells (ADSCs). These cells hold promise in regenerative medicine, showing enhanced abilities compared with ADSCs from other sources. The omentum is critical in tissue repair and pathology, making it invaluable in veterinary surgery across various medical fields. The aim of this article was to research current knowledge about the applications of the omentum in veterinary surgery and the possibilities of using this structure in the future.
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Affiliation(s)
- Magdalena Morawska-Kozłowska
- Department of Surgery and Radiology with Clinic, Faculty of Veterinary Medicine, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland
| | - Aleksandra Wilkosz
- Department of Surgery and Radiology with Clinic, Faculty of Veterinary Medicine, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland
| | - Yauheni Zhalniarovich
- Department of Surgery and Radiology with Clinic, Faculty of Veterinary Medicine, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland
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2
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Smit JM, Plat VD, Panday AN, Daams F, Negenborn VL. What are the short- and long-term abdominal consequences of an omentectomy? A systematic review. J Surg Oncol 2024; 129:1420-1429. [PMID: 38606519 DOI: 10.1002/jso.27640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
This review provides an overview regarding the abdominal effects of an omentectomy, with or without extra-peritoneal reconstructions. In general, reported complication rates were low. Short-term complications involved ileus, bowel stenosis, abdominal abscess and sepsis (range 0.0%-23%). Donor-site hernia was mainly reported as long-term complication (up to 32%) and negligible gastrointestinal complications were observed. However, the level of evidence and methodological quality are quite low with a maximum of 8.5 years follow-up.
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Affiliation(s)
- Jan Maerten Smit
- Department of Plastic, Reconstructive- and Hand surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - Victor D Plat
- Department of Plastic, Reconstructive- and Hand surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - Arvind Nannan Panday
- Department of Plastic, Reconstructive- and Hand surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - Freek Daams
- Department of Gastrointestinal Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - Vera L Negenborn
- Department of Plastic, Reconstructive- and Hand surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
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3
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Lanzaro L, Caixeiro L, Baptista D, Zenha H, Viveiros F, Resende M, Costa H. Refining reconstructive arsenal: Free omental flap with autologous bone graft for complex craniofacial defects after tumor resection and frontal osteoradionecrosis. JPRAS Open 2024; 39:152-156. [PMID: 38269256 PMCID: PMC10806279 DOI: 10.1016/j.jpra.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/03/2023] [Indexed: 01/26/2024] Open
Abstract
Skull osteoradionecrosis may happen after radiation therapy for head and neck cancer. Here in, the authors present a case of intracranial carcinoma with osteoradionecrosis and exposure of frontal bone with a large communication between nasal cavity and anterior fossa associated. The patient was successfully treated with resection of the tumor and reconstruction omentum free flap wrapped around autologous bone graft.
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Affiliation(s)
- Larissa Lanzaro
- Centro Hospitalar de Vila Nova de Gaia/Espinho Serviço de Cirurgia Plástica Reconstrutiva, Craniomaxilofacial e Mão, Unidade de Microcirurgia. Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
| | - Leonor Caixeiro
- Centro Hospitalar de Vila Nova de Gaia/Espinho Serviço de Cirurgia Plástica Reconstrutiva, Craniomaxilofacial e Mão, Unidade de Microcirurgia. Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
| | - Daniel Baptista
- Centro Hospitalar de Vila Nova de Gaia/Espinho Serviço de Cirurgia Plástica Reconstrutiva, Craniomaxilofacial e Mão, Unidade de Microcirurgia. Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
| | - Horácio Zenha
- Centro Hospitalar de Vila Nova de Gaia/Espinho Serviço de Cirurgia Plástica Reconstrutiva, Craniomaxilofacial e Mão, Unidade de Microcirurgia. Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
| | - Fernando Viveiros
- Centro Hospitalar de Vila Nova de Gaia/Espinho Serviço de Cirurgia Plástica Reconstrutiva, Craniomaxilofacial e Mão, Unidade de Microcirurgia. Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
| | - Mário Resende
- Centro Hospitalar de Vila Nova de Gaia/Espinho Serviço de Cirurgia Plástica Reconstrutiva, Craniomaxilofacial e Mão, Unidade de Microcirurgia. Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
| | - Horácio Costa
- Centro Hospitalar de Vila Nova de Gaia/Espinho Serviço de Cirurgia Plástica Reconstrutiva, Craniomaxilofacial e Mão, Unidade de Microcirurgia. Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
- University of Aveiro, Portugal
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Claessens AAE, van Onna MA, Maaskant S, Broekhuysen CL. A long-term follow up of the laparoscopically harvested free omental flap for breast reconstruction. Microsurgery 2024; 44:e31137. [PMID: 38151974 DOI: 10.1002/micr.31137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 10/23/2023] [Accepted: 12/08/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND There are different types of reconstruction after mastectomy and breast-conserving surgery. Autologous reconstructions are nowadays more often preferred over implant-based reconstructions for many reasons. A more natural looking breast with a durable long-term result is one of the advantages. The greater omentum is frequently used in the general field of reconstructive surgery but has not been widely adopted in breast surgery. This report is the first larger series of patients who underwent a breast reconstruction using the laparoscopically harvested omental free flap (LHOFF). The aim of this report is to provide information about indication, surgical technique, short- and long-term complications, and patient satisfaction with aesthetic outcomes and health-related quality of life (HR-QoL). METHODS Patients underwent a breast reconstruction with the LHOFF from 2014 to 2021 in Máxima Medical Center, Veldhoven, the Netherlands. All patients underwent a diagnostic laparoscopy prior to the reconstruction to examine whether the volume of omentum was deemed sufficient. Outcome measures included the Breast-Q for HR-QoL, patient satisfaction, short- and long-term complications, and abdominal complaints related to the transplanted omentum. Surgical data were retrieved retrospectively. RESULTS Twenty-six patients were included in this article. Patients were 40 to 71 years old with a mean BMI of 21.5 (range 17.0-25.0). Mean weight of the omental free flap was 228 g (range 112-395). Four out of 26 cases underwent surgery due to venous congestion. There was one case of flap failure due to venous thrombosis. Mean time of follow-up was 54 months (range 8-179). Secondary corrections include a nipple reconstruction (n = 11), lipofilling (n = 11), a contralateral breast reduction (n = 3) or a breast implant (n = 2). Patients reported improvement in HR-QoL and good satisfaction with aesthetic outcomes. No abdominal complications were reported during the follow-up period. CONCLUSION The LHOFF is an autologous breast reconstruction technique that results in a soft, small breast with natural ptosis and minimal donor site morbidities. Patients report satisfactory aesthetic outcomes and good quality of life. The main limitation of this technique is the limited amount of volume of the omentum and the possible need for secondary corrections. No abdominal complications were reported. In the future, larger prospective studies are required to support implementation of the LHOFF reconstruction on a broader scale.
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Affiliation(s)
- Anouk A E Claessens
- Department of General Surgery, Máxima Medical Center Veldhoven (MMC Veldhoven), Veldhoven, the Netherlands
| | - Martijn A van Onna
- Department of Plastic, Reconstructive and Hand Surgery, Máxima Medical Center Veldhoven (MMC Veldhoven), Veldhoven, the Netherlands
| | - Sabrina Maaskant
- Department of General Surgery, Máxima Medical Center Veldhoven (MMC Veldhoven), Veldhoven, the Netherlands
| | - Coralien L Broekhuysen
- Department of Plastic, Reconstructive and Hand Surgery, Máxima Medical Center Veldhoven (MMC Veldhoven), Veldhoven, the Netherlands
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Delia G, Battaglia F, Cigna E, Ioppolo L, Maruccia M, d'Alcontres FS. Medial fascia lata perforator flap: Anatomical basis and clinical application as a pedicled or free flap. JPRAS Open 2023; 38:25-35. [PMID: 37662865 PMCID: PMC10474130 DOI: 10.1016/j.jpra.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 07/27/2023] [Indexed: 09/05/2023] Open
Abstract
Adipofascial flaps have proven to be an excellent tool for multipurpose reconstruction as free or pedicled flaps. The anatomical studies in this field are now focused on improving esthetics in reconstruction while maintaining a minimal donor site morbidity. An anatomical cadaver study has been carried out to investigate the medial thigh region as a potential donor site for adipofascial flaps. Eighteen thighs from fresh cadavers were dissected and a new territory with autonomous vascular supply was defined through vascular injection, anatomical dissection, transillumination, and angiography. Cutaneous access was made in a "T" shape. The fascia harvests had to be centered on the adductor longus and gracilis muscles bearing in mind the position of the flap pedicle. The fascial flap was isolated from adductor longus and gracilis muscles and isolated on his pedicle (medial circumflex femoral artery). After our anatomical study, we used the flap in 2 clinical cases. The results of our anatomical study and clinical cases confirmed the suitability and reliability of a new flap: the "Medial Fascia Lata Flap." Flap size ranged from 20 to 25 cm and has the advantage of preserving the functionality of the thigh muscles. The study showed that the "Medial Fascia Lata Flap" is easy to harvest, and the resulting scar is concealed. In consideration of its suitability, reliability and aesthetical advantages, it could be proposed as a good option in selected cases.
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Affiliation(s)
- Gabriele Delia
- Plastic Reconstructive and Aesthetic Surgery Unit, University of Messina, Policlinico 'G. Martino', Via Consolare Valeria 1, 98125 Messina, Italy
| | - Fabiana Battaglia
- Plastic Reconstructive and Aesthetic Surgery Unit, University of Messina, Policlinico 'G. Martino', Via Consolare Valeria 1, 98125 Messina, Italy
| | - Emanuele Cigna
- Plastic Surgery and Microsurgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56122 Pisa, Italy
| | | | - Michele Maruccia
- Section of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Francesco Stagno d'Alcontres
- Plastic Reconstructive and Aesthetic Surgery Unit, University of Messina, Policlinico 'G. Martino', Via Consolare Valeria 1, 98125 Messina, Italy
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Hashemi ASA, Gimenez A, Yim N, Bay C, Grush AE, Heinle JS, Buchanan EP. Anterior Chest Wall Reconstruction After Separation of Thoraco-Omphalopagus Conjoined Twins With Cadaveric Rib Grafts and Omental Flap. Ann Plast Surg 2023; 91:753-757. [PMID: 38079320 DOI: 10.1097/sap.0000000000003645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Anterior chest wall defects have a wide range of etiologies in the pediatric population, ranging from infection, tumor, and trauma to congenital diseases. The reconstructive goals include restoring skeletal stability, obliterating dead space, preserving cardiopulmonary mechanics, and protecting vital underlying mediastinal organs. Although various reconstructive methods have been described in the literature, selecting the optimal method is challenging for the growing pediatric skeleton. Here, we report a case of previously thoraco-omphalopagus twins who underwent successful separation and reconstruction and presented for definitive anterior chest wall reconstruction. METHODS A pair of previously thoraco-omphalopagus conjoined twins underwent definitive anterior chest wall defect reconstruction using cadaveric ribs and omental flap. Twin A received 2 cadaveric ribs, whereas twin B had a much larger sternal defect that required 3 cadaveric ribs combined with an omental flap for soft tissue chest coverage. Both twins were followed up for 8 months. RESULTS Twin A's postoperative course was uneventful, and she was discharged on postoperative day 6. Twin B's course was complicated, and she was discharged on supported ventilation on postoperative day 10. At 8 months postoperatively, both twins healed well, and chest radiographs confirmed the stability of the chest reconstructions. The rib grafts in the twin with a tracheostomy were not mobile, and the patient had a solid sternum with adequate pulmonary expansion. The construct initially did not facilitate pulmonary functioning, but after a healing process, it eventually allowed for the twin with the tracheostomy who required pulmonary assistance to no longer need this device. CONCLUSIONS Cryopreserved cadaveric ribs and omental flaps offer safe and reliable reconstructive methods to successfully reconstruct congenital anterior chest wall skeletal defects in the growing pediatric population. The involvement of multidisciplinary team care is key to optimizing the outcomes.
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Affiliation(s)
| | - Alejandro Gimenez
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
| | | | - Caroline Bay
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
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7
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Ten-year experience with laparoscopic pedicled omental flap for cerebral revascularization in patients with Moyamoya disease. J Pediatr Surg 2022; 57:710-715. [PMID: 35197196 DOI: 10.1016/j.jpedsurg.2022.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/13/2022] [Accepted: 01/19/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The omental flap has numerous extraperitoneal applications in reconstruction and revascularization given its favorable immunologic and angiogenic properties. In patients with Moyamoya disease, cerebral revascularization using a pedicled omental flap has proven to be a viable option following direct revascularization procedures. Historically, harvesting omentum involved laparotomy with the associated risk of complications; herein we describe outcomes from a 10-year experience of laparoscopic harvesting of pedicled omental flap for cerebral revascularization in Moyamoya patients. METHODS A retrospective chart review was performed of all patients with Moyamoya disease who underwent laparoscopic omental cerebral transposition between 2011 and 2021. Intraoperative and postoperative complications, length of stay (LOS), and outcomes at follow-up were analyzed. RESULTS Twenty-one patients underwent the procedure during the study period. Three intraoperative complications occurred (one segmental transverse colectomy for mesenteric injury, one converted to omental free flap, and one requiring micro anastomosis). Average overall LOS was 6 ± 6 days, with 3 ± 3.5 days in the ICU (mean±SD). Following discharge, complications included epigastric incisional hernia at the graft fascial exit site, recurrent neck pain at subcutaneous tunneling site, and partial scalp necrosis. One patient required subsequent direct bypass seven months after the initial procedure owing to the progression of the disease. All other patients had partial or complete resolution of symptoms. CONCLUSION Our retrospective observational study indicates that laparoscopic pedicled omental flap mobilization and transposition is a safe and effective method of indirect cerebral revascularization in patients with Moyamoya disease. LEVEL OF EVIDENCE N/A.
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Deptula P, Zak Y, Dua M, Wapnir I, Nguyen D. Minimizing Postoperative Pain in Autologous Breast Reconstruction With the Omental Fat-Augmented Free Flap. Ann Plast Surg 2022; 88:S374-S378. [PMID: 35180753 DOI: 10.1097/sap.0000000000003084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The omental fat-augmented free flap (O-FAFF) is a recently developed technique for autologous breast reconstruction. Our aim of the study is to evaluate the outcomes of our early case series. We assess the O-FAFF donor site morbidity in terms of postoperative pain, narcotic, and antiemetic use. METHODS A retrospective analysis of patients undergoing O-FAFF from 2019 to 2021 was performed. Patients were evaluated for demographic data, operative time, hospital course, and complications. Mean pain scores (1-10 scale) and narcotic pain medication use in oral morphine equivalents and doses of antiemetic medications during their hospital course were analyzed. We compared outcomes of our O-FAFF group with those of a control group of patients who underwent breast reconstruction with traditional free abdominal tissue transfer. RESULTS A total of 14 patients underwent O-FAFF breast reconstruction, representing 23 breasts. Patients had an average age of 48.5 years (±2.3 years) and body mass index of 22.6 kg/m 2 (±1.09 kg/m 2 ). Average follow-up was 232 days (±51 days). Average mastectomy weight was 245.6 g (±30.2 g) and average O-FAFF weight was 271 g (±31.7 g). Average pain scores on postoperative day 1 (POD1), POD2, and POD3 were 3.1 (±0.28), 2.8 (±0.21), and 2.1 (±0.35), respectively. The average narcotic use by patients in oral morphine equivalents on POD1, POD2, and POD3 are 24.3 (±5.5), 21.9 (±4.6), and 6.2 (±2.4), respectively. Total narcotic use during hospital stay was 79.4 mg (±11.1 mg). Average pain scores and narcotic use are significantly lower when compared with a previously published cohort of patients who underwent autologous breast reconstruction with free abdominal tissue transfer ( P < 0.05). Average antiemetic use was lower in the O-FAFF group compared with the control group: 3.5 versus 4.8 doses ( P = 0.6). Hospital length of stay was 3.0 days (±0.0 days). No complications were noted (0%). Patients were universally satisfied with their reconstructive outcome (100%). CONCLUSIONS The O-FAFF is proven to be a viable method of autologous breast reconstruction. Early series of patients undergoing O-FAFF reconstruction suggest a lower donor site morbidity as demonstrated by lower postoperative pain scores and lower consumptions of narcotic pain medications.
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Affiliation(s)
- Peter Deptula
- From the Department of Surgery, Stanford University Medical Center, Stanford, CA
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9
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Pedicled Omental Transposition for Recurrent Skin Erosion Following Deep Brain Stimulation Without Hardware Removal. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03354-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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10
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Sarwal D, Yu N, Veeramachaneni N, Aslinia F. The Key Role of Upper Endoscopy in Diagnosing Gastric Herniation and Volvulus in Acute Gastrointestinal Obstruction. Case Rep Gastroenterol 2022; 16:252-257. [PMID: 35611124 PMCID: PMC9082190 DOI: 10.1159/000521917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/07/2022] [Indexed: 11/24/2022] Open
Abstract
The diagnosis of gastric volvulus can be a clinical challenge as it is rare, and the symptoms are often nonspecific and intermittent. Upper endoscopy is a minimally invasive intervention that may be repeated more than once to provide key information and ultimately establish such a diagnosis. To emphasize the role of upper endoscopy in surgical cases with recurrent upper gastrointestinal obstructions, we present a case of intermittent gastric volvulus in a patient with a remote history of complex chest wall reconstruction for invasive breast cancer using an omental flap. She presented with substernal chest pain, belching, nausea, and vomiting. Although the initial imaging suggested duodenal obstruction, exploratory laparotomy and intraoperative upper endoscopy did not show any pathology in the stomach or duodenum. Repeat upper endoscopy due to recurrence of obstructive symptoms shortly after the initial exploratory laparotomy revealed a gastric volvulus. This resulted in abnormal duodenal orientation which caused intermittent duodenal obstruction while the pathology was in the stomach. Gastric volvulus may be spontaneously reducible, leading to discordance in findings during the clinical course. This could explain the absence of visible twisting on initial exploratory laparotomy in this patient and the subsequent findings of volvulus on upper endoscopy. Thus, it is important to consider gastric volvulus as a possible cause of symptoms despite initial negative findings as it is a dynamic process and may only be discovered through relook upper endoscopy and imaging.
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11
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Laun J, Park YJ, Rotatori RM, Gonzalez R, Panetta N. Omental Flap to Non-healing Posterior Trunk Wound: A Case Report. Cureus 2021; 13:e20178. [PMID: 35004003 PMCID: PMC8723772 DOI: 10.7759/cureus.20178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2021] [Indexed: 11/10/2022] Open
Abstract
Large posterior trunk wounds often require flap reconstruction. One option for posterior truncal reconstruction not readily considered, often due to the combined anterior and posterior approaches required for harvesting and coverage, is the omental flap; however, the omental flap stands as a robust backup in non-healing wounds when local flap options have been exhausted. We present a case of a posterior trunk wound that had previously undergone multiple unsuccessful local and regional flaps for reconstruction and was ultimately treated with a pedicled omental flap which went on to heal without any post-operative complications.
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Abstract
Soft tissue wounds in the scalp are a common occurrence after trauma or resection of a malignancy. The reconstructive surgeon should strive to use the simplest reconstructive technique while optimizing aesthetic outcomes. In general, large defects with infection, previous irradiation (or require postoperative radiation), or with calvarial defects usually require reconstruction with vascularized tissue (ie, microvascular free tissue transfer). Smaller defects greater than 3 cm that are not amenable to primary closure can be treated with local flap reconstruction. In all cases, the reconstruction method will need be tailored to the patient's health status, desires, and aesthetic considerations.
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13
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El‐Sherpiny WY, Abdelshafi AM, Ghazaly M, Elnemr AA, Darwish AA, Mlees MA. Comparative study between laparoscopically harvested omental flap and glandular flap in immediate reconstruction after conservative surgery in breast cancer. SURGICAL PRACTICE 2021. [DOI: 10.1111/1744-1633.12492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Mohamed Ghazaly
- Department of General Surgery, Faculty of Medicine Tanta University Tanta Egypt
| | - Ayman A. Elnemr
- Department of General Surgery, Faculty of Medicine Tanta University Tanta Egypt
| | - Ahmed A. Darwish
- Department of General Surgery, Faculty of Medicine Tanta University Tanta Egypt
| | - Mohamed A. Mlees
- Department of General Surgery, Faculty of Medicine Tanta University Tanta Egypt
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Management of Osteoradionecrosis of the Anterior Thoracic Wall Using Omental Flaps: a Prospective Case Series and Literature Review. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02835-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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15
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Trapero A, Pérez-García A, Thione A, Carpio MA, Oliete JB. Omental free flap for surgical treatment of chronic osteomyelitis of lower limb: A technical note. Injury 2021; 52:1065-1068. [PMID: 33046247 DOI: 10.1016/j.injury.2020.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/06/2020] [Accepted: 10/05/2020] [Indexed: 02/02/2023]
Abstract
Soft tissue reconstruction of chronic lower extremity wounds with bone infection entails an important challenge in reconstructive surgery. We report our experience using the omentum free flap to provide coverage in two patients suffering chronic osteomyelitis of the lower limbs. After extensive soft tissue and bone debridement, an omentum free flap was performed in both cases, providing dead space obliteration and soft tissue coverage in behalf of its large size and pliability. As a result, the chronic illness was eradicated in both patients, with satisfactory outcomes and infection resolution.
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Affiliation(s)
- Ana Trapero
- Hospital Universitari i Politècnic La Fe, Plastic and Reconstructive Surgery Division - Valencia - Spain
| | - Alberto Pérez-García
- Hospital Universitari i Politècnic La Fe, Plastic and Reconstructive Surgery Division - Valencia - Spain.
| | - Alessandro Thione
- Hospital Universitari i Politècnic La Fe, Plastic and Reconstructive Surgery Division - Valencia - Spain
| | - Miriam Alonso Carpio
- Hospital Universitari i Politècnic La Fe, Plastic and Reconstructive Surgery Division - Valencia - Spain
| | - José Baeza Oliete
- Hospital Universitari i Politècnic La Fe, Plastic and Reconstructive Surgery Division - Valencia - Spain
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16
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Day SJ, Dy B, Nguyen MD. Robotic omental flap harvest for near-total anterior chest wall coverage: a potential application of robotic techniques in plastic and reconstructive surgery. BMJ Case Rep 2021; 14:14/2/e237887. [PMID: 33622742 PMCID: PMC7907868 DOI: 10.1136/bcr-2020-237887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present the robotic harvest of a pedicled omentum flap for reconstruction of a near-total anterior chest wall defect. The patient was a 68-year-old woman with recurrent secondary chest wall angiosarcoma after previous mastectomy and radiation therapy. She underwent neoadjuvant chemotherapy and radiation, followed by wide radical chest wall resection with a final defect size of 15×35 cm. A one-stage reconstruction was performed with an omentum flap harvested by robotic technique and split-thickness skin grafts from thigh donor sites. The patient healed with minimal complications. Our case supports more widespread application of robotics in plastic and reconstructive surgery.
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Affiliation(s)
| | - Benzon Dy
- Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA
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17
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Use of the Omental Free Flap for Treatment of Chronic Anterior Skull Base Infections. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2988. [PMID: 32983763 PMCID: PMC7489647 DOI: 10.1097/gox.0000000000002988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/26/2020] [Indexed: 11/26/2022]
Abstract
Chronic complications following anterior cranial fossa tumor extirpation, such as cerebrospinal fluid leak, meningitis, mucocele, pneumocephalus, and abscess, negatively impact patient quality of life. Robust vascularized tissue is generally required to adequately reconstruct and obliterate this complex geometric space. The aim of this study was to describe outcomes and advantages of the omental flap for these defects. Following institutional review board approval, a prospective, reconstructive database was reviewed from 2011 to 2020. Four patients with chronic anterior skull base complications treated with omental flap reconstruction were identified, with chart reviews performed. Median time from the index operation until the complication ultimately required a free omental transfer was 7.3 years. All patients underwent adjuvant radiation with the indications for surgery, including cerebral abscess, recurrent meningitis, osteomyelitis, and pneumocephalus. All free flaps survived without any need for revision. There were no donor site complications. One patient had delayed healing at an adjacent nasal wound that healed secondarily. At a median follow-up of 19.4 months, none of the patients had recurrent infections. The omental free flap has a number of properties, which make it ideally suitable for anterior skull base defects. Its malleable nature combined with the presence of multiple vascular arcades enable flexibility in flap design to contour to the crevices of 3-dimensional skull base defects. Although other free flaps are available to the plastic surgeon, the versatility and reliability of the omentum make it a first-line consideration for anterior skull base reconstruction.
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Kaya B, Ciudad P, Chen SH, Para L, Chen HC. Technical details for harvesting gastro-epiploic lymph node flaps via mini-laparotomy incision. J Plast Reconstr Aesthet Surg 2020; 73:1630-1636. [PMID: 32475737 DOI: 10.1016/j.bjps.2020.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 02/08/2020] [Accepted: 05/09/2020] [Indexed: 10/24/2022]
Abstract
Laparoscopic harvest method to obtain gastro-epiploic lymph node flaps for lymphedema treatment has been previously described. In this article, the technical details of an alternative method - open approach via mini-laparotomy incision - for harvesting gastro-epiploic lymph node flaps and preparation of the flaps for the inset is presented. A total of 17 patients were included in this series of the mini-laparotomy approach. Blood loss was minimal during the surgery. The average duration of lymph node flap harvest was 65 min. The average length of hospital stay was 10 days. The period of the restricted diet was 1.5 days. The upper abdominal scar was acceptable, there were no postoperative hernia or bulging, and there were no complications related to bowel obstruction during the follow-up. The open approach harvest method via mini-laparotomy incision offers similar results to laparoscopic harvest method, and it is safe when applied with the right technique.
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Affiliation(s)
- Burak Kaya
- Department of Plastic Surgery, China Medical University and China Medical University Hospital, 2, Yuh-Der Road, Taichung 40447, Taiwan; Ankara University Faculty of Medicine, Ankara, Turkey
| | - Pedro Ciudad
- Department of Plastic Surgery, China Medical University and China Medical University Hospital, 2, Yuh-Der Road, Taichung 40447, Taiwan
| | | | - Luis Para
- Department of Plastic Surgery, China Medical University and China Medical University Hospital, 2, Yuh-Der Road, Taichung 40447, Taiwan
| | - Hung-Chi Chen
- Department of Plastic Surgery, China Medical University and China Medical University Hospital, 2, Yuh-Der Road, Taichung 40447, Taiwan.
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Romanelli M, Dini V, Milani M. Topical purified omental lipid formulations in the prevention of skin ulcers: a narrative review. J Wound Care 2020; 28:284-290. [PMID: 31067163 DOI: 10.12968/jowc.2019.28.5.284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The omentum is a large peritoneal fold. Its main function is to protect abdominal organs, exerting a defensive action against infective agents. The tissue promotes repair after several types of injury. An extensive vascularisation is the key characteristic of this tissue and the omentum has the highest level of production and content of vascular endothelial growth factor (VEGF). A component of omentum is the lipid compound, which carries out important activities for the organism. Omentum is rich in neutral glycerides, phospholipids, glycolipids and gangliosides. Dermatological products containing purified omental lipids are commercially available and topical omental extracts have been useful in the softening, moisturising and smoothing of skin. Animal-derived omental lipids could be use in topical products with different textures (creams, fluids, emulsions and cleansers) and at different concentrations (10-25%) for the treatment of fragile skin or skin conditions causing risk of ulcer formation. This review summarises the pharmacological rationale of purified omental lipids in topical formulations for use in fragile skin conditions, the clinical efficacy data available in the scientific literature and the potential future perspectives. Efficacy of topical purified omental lipids have been demonstrated in numerous clinical controlled trials involving a total of 320 subjects. These studies demonstrated that this product helps prevent the formation of pressure ulcers (PU) in hospitalised high-risk subjects, improves wound healing process, normalises skin hydration in diabetic subjects with moderate-severe skin xerosis and improve the clinical evolution of diabetic foot. Therefore, purified omental lipid could be an effective tool for the management of fragile skin and the skin at high risk of PU formation.
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Affiliation(s)
- Marco Romanelli
- Department of Dermatology, Wound Healing Research Unit, University of Pisa
| | - Valentina Dini
- Department of Dermatology, Wound Healing Research Unit, University of Pisa
| | - Massimo Milani
- Medical Department Cantabria Labs Difa Cooper, Caronno Pertusella Italy
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An Algorithmic Approach to Perineal Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2572. [PMID: 32537311 PMCID: PMC7288874 DOI: 10.1097/gox.0000000000002572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/18/2019] [Indexed: 01/11/2023]
Abstract
Perineal wounds are one of the more challenging plastic surgical defects to reconstruct. Resections in the perineum vary in size and are frequently complicated by radiation, chemotherapy, and contamination. Furthermore, the awkward location and potential need to maintain function of the anus, urethra, and vagina and to allow comfortable sitting all contribute to the complexity of these reconstructions. In light of this complex nature, many options are available for flap coverage. In this paper, we discuss the properties of perineal defects that make each option appropriate.
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Challenges in Microsurgical Reconstruction for Craniofacial Osteomyelitis With Resultant Osteonecrosis. J Craniofac Surg 2019; 30:1960-1965. [PMID: 31232982 DOI: 10.1097/scs.0000000000005594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Chronic osteomyelitis is characterized by compromised blood supply and eventual osteonecrosis. Definitive treatment requires aggressive resection of affected bone. The resultant defect poses a unique challenge to reconstructive surgeons. Much of the literature on craniofacial osteomyelitis focuses on infection eradication, rather than subsequent reconstruction. This article reports representative cases from our experience with free flap reconstruction for defects secondary to chronic osteomyelitis of the craniofacial skeleton. METHODS/RESULTS The authors selected 5 of the most difficult reconstructive cases of craniofacial osteomyelitis from our experience in a single tertiary referral institution with a follow-up of at least 6 months. Three of the 5 cases arose in the setting of previous head and neck cancer treated with resection and radiation therapy. One case had a previous surgical craniotomy complicated by osteomyelitis and multiple failed alloplastic reconstructions. The final case was due to multiple gunshots to the head, with subsequent cerebral and cranial abscess (>1000cc). In each case, the defect was successfully treated with free tissue transfer. Two cases required creation of recipient vessels with an arteriovenous loop. CONCLUSIONS Free tissue transfer provides a versatile and effective tool in the reconstruction of extensive craniofacial osteomyelitis defects. Furthermore, the addition of vascularized tissue can protect against further episodes of osteomyelitis. Finally, arteriovenous loops can be employed successfully when prior radiation and infection of the wound bed precludes the use of local recipient target vessels.
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Unusual duplication and vulnerable intrapancreatic course of the left gastroepiploic artery: a rare anatomical variation. Surg Radiol Anat 2019; 41:351-353. [PMID: 30725215 DOI: 10.1007/s00276-019-02188-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
Abstract
The left gastroepiploic artery (LGEA) is the least described artery in the medical literature. Unusual variations of this artery might lead to vascular injuries, causing intraoperative bleeding after surgery. We observed rare vascular variations in an adult male cadaver. The left gastroepiploic artery after its origin from splenic artery pierced the pancreatic parenchyma at its posterior surface. After a short intrapancreatic course, the LGEA emerged out from the superior border of the body of the pancreas. LGEA then trifurcated into an omental branch, duplicated LGEA and another branch that continued as the main trunk of LGEA. Main LGEA and duplicated LGEA coursed towards the greater curvature of the stomach. The main LGEA ended by anastomosing with the right gastroepiploic artery, while the duplicated LGEA ended at the greater curvature of the stomach by ramifying into minute branches on the walls of the stomach and gave few gastric branches to supply the stomach and also supplied the greater omentum. This variation was associated with the presence of an accessory splenic artery. Anatomists, surgeons, and radiologists should be aware of such anomalous vascular variations as it could help to minimize complications related to pancreatectomy, omentoplasty, and resection of pancreatic tumors.
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Rudman F, Barić D, Unić D. Omentum flap as a salvage procedure in deep sternal wound infection. Ther Clin Risk Manag 2017; 13:1495-1497. [PMID: 29184414 PMCID: PMC5687791 DOI: 10.2147/tcrm.s151811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Franjo Rudman
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital "Dubrava"
| | - Davor Barić
- Department of Cardiac and Transplant Surgery, University Hospital "Dubrava", Zagreb, Croatia
| | - Daniel Unić
- Department of Cardiac and Transplant Surgery, University Hospital "Dubrava", Zagreb, Croatia
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Spindler N, Etz CD, Misfeld M, Josten C, Mohr FW, Langer S. Omentum flap as a salvage procedure in deep sternal wound infection. Ther Clin Risk Manag 2017; 13:1077-1083. [PMID: 28883736 PMCID: PMC5574694 DOI: 10.2147/tcrm.s134869] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Deep sternal wound infections (DSWIs) are rare but devastating complication after median sternotomy following cardiac surgery. Especially in the presence of artificial material or inadequate preliminary muscle flaps, the pedicled omentum flap is due to its immunological properties, the predetermined flap in salvage procedures. METHODS We treated 14 patients suffering a mediastinitis and open thorax using a pedicled omentoplasty as a salvage procedure because of persisting DSWIs. Omentoplasty was performed in combination with a split skin graft and the wound was closed by a vacuum-assisted therapy for 7 days. The patients' sex and comorbid risk factors supporting DSWIs as well as the postoperative complications were recorded. RESULTS Retrospective analysis of 14 patients (10 males and four females) after a follow-up time of 24 months was performed. The average age was 75 years (range: 67-83). Heart surgery took place electively in eight cases, in three cases urgently and three for emergency reasons. The preoperative Euro Score was 16 (range 3.51-42.58). We had no flap loss in any patients. The skin graft showed a full take in all patients. Two patients needed revision of an abdominal wound dehiscence after laparotomy and one patient developed hernia in the late outcome. DISCUSSION The greater omentum flap has, over many years, become an ideal partner in the coverage and treatment of DSWIs. Especially due to its immunologic capacity and amorphous structure, it has the ability to fill up cavities and cover infected artificial material so residual infections can be controlled.
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Affiliation(s)
- Nick Spindler
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig
| | - Christian D Etz
- Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Martin Misfeld
- Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Christoph Josten
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig
| | - Friedrich-Wilhelm Mohr
- Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Stefan Langer
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig
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Successful Laparoscopic Harvesting of Omental Pedicle Flap for Salvage Cerebral Revascularization in 2 Adults With Moyamoya Disease: Technique and Lessons Learned. Surg Laparosc Endosc Percutan Tech 2017; 27:e111-e115. [PMID: 28708772 DOI: 10.1097/sle.0000000000000448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Moyamoya is an idiopathic and progressive disease that leads to occlusion of intracranial arteries. When other methods of revascularization fail, omentum can be used as an indirect bypass to improve cerebral perfusion. Laparoscopic mobilization of a pedicled omental flap with subcutaneous tunneling to the brain has been described in small case series in children. We report our techniques and outcomes in 2 adults with Moyamoya to undergo such a procedure. An omental flap based on the right gastroepiploic artery was created and intraoperative fluorescence imaging using indocyanine green was used to assess the viability of the flap and to guide lengthening of the pedicle. The flap was tunneled subcutaneously using skip incisions. There were no intraoperative complications and no postoperative complications related to the omental flap. Follow-up evaluation demonstrates viable omental flaps and improved cerebral vascularization. This technique is feasible in adults who require salvage cerebral revascularization for Moyamoya disease.
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Costantino PD, Shamouelian D, Tham T, Andrews R, Dec W. The Laparoscopically Harvested Omental Free Flap: A Compelling Option for Craniofacial and Cranial Base Reconstruction. J Neurol Surg B Skull Base 2016; 78:191-196. [PMID: 28321385 DOI: 10.1055/s-0036-1597138] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/23/2016] [Indexed: 10/20/2022] Open
Abstract
Background Management of craniofacial and cranial base tumors is a challenge due to the anatomic intricacies associated with the calvarium, the pathological diversity of lesions that present, and the potential complications. Clinical outcomes in laparoscopically harvested omentum free flaps for cranial base and craniofacial reconstruction are presented in this paper, in the largest case series to date. Methods A retrospective single-center experience for over 10 years with laparoscopically harvested omentum flaps used to reconstruct craniofacial and cranial base defects. Results A total of 13 patients underwent craniofacial or cranial base reconstruction using laparoscopically harvested omentum free flaps. The mean patient age was 48 years. The anterior skull base represented the most common site of reconstruction. A total of 12 of the flaps survived (92%), with one flap failure due to infection. All patients demonstrated satisfactory aesthetic and functional outcomes. There were no perioperative or intra-abdominal complications. Conclusions The laparoscopically harvested omentum free flap is a safe and effective tool in the armamentarium of the reconstructive surgeon. It is the ideal option to treat complex, three-dimensional subcutaneous defects, such as those encountered in craniofacial and cranial base reconstruction. Its unique angiogenic and immunologic capacity makes it an excellent flap for the previously irradiated and/or infected wound bed.
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Affiliation(s)
- Peter D Costantino
- New York Head and Neck Institute, Northwell Health System, New York, United States
| | - David Shamouelian
- New York Head and Neck Institute, Northwell Health System, New York, United States
| | - Tristan Tham
- New York Head and Neck Institute, Northwell Health System, New York, United States
| | - Robert Andrews
- Department of Surgery, Lenox Hill Hospital, New York, United States
| | - Wojciech Dec
- Department of Plastic Surgery, Lenox Hill Hospital, New York, United States
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Steiner D, Hubertus A, Arkudas A, Taeger CD, Ludolph I, Boos AM, Schmitz M, Horch RE, Beier JP. Scalp reconstruction: A 10-year retrospective study. J Craniomaxillofac Surg 2016; 45:319-324. [PMID: 28043755 DOI: 10.1016/j.jcms.2016.11.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 10/14/2016] [Accepted: 11/30/2016] [Indexed: 11/18/2022] Open
Abstract
Scalp reconstruction is a challenging task for the reconstructive surgeon. In consideration of the anatomical and cosmetic characteristics, the defect depth and size, an armamentarium of reconstructive procedures ranging from skin grafts over local flaps to free tissue transfer has been described. In this 10-year retrospective study, 85 operative procedures for scalp reconstruction were performed at our department. The underlying entity, defect size/depth, reconstructive procedure, complications, and mean hospital stay were analyzed. In most cases, scalp reconstruction was necessary after oncologic resection (67%) or radiation therapy (16%). A total of 85 operative procedures were performed for scalp reconstruction including local flaps (n = 50), free tissue transfer (n = 18), and skin grafts (n = 17). Regarding the complication rate, we could detect an overall major complication rate of 16.5% with one free flap loss. Briefly, local flaps are an adequate and safe procedure for limited scalp defects. In the case of extensive scalp defects affecting the calvarium, prior multiple surgical interventions and/or radiation, we prefer free tissue transfer.
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Affiliation(s)
- D Steiner
- Department of Plastic and Hand Surgery (Head: Univ. Prof. Dr. med. Dr. h.c. R. E. Horch), University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - A Hubertus
- Department of Plastic and Hand Surgery (Head: Univ. Prof. Dr. med. Dr. h.c. R. E. Horch), University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - A Arkudas
- Department of Plastic and Hand Surgery (Head: Univ. Prof. Dr. med. Dr. h.c. R. E. Horch), University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - C D Taeger
- Department of Plastic and Hand Surgery (Head: Univ. Prof. Dr. med. Dr. h.c. R. E. Horch), University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - I Ludolph
- Department of Plastic and Hand Surgery (Head: Univ. Prof. Dr. med. Dr. h.c. R. E. Horch), University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - A M Boos
- Department of Plastic and Hand Surgery (Head: Univ. Prof. Dr. med. Dr. h.c. R. E. Horch), University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - M Schmitz
- Department of Plastic and Hand Surgery (Head: Univ. Prof. Dr. med. Dr. h.c. R. E. Horch), University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - R E Horch
- Department of Plastic and Hand Surgery (Head: Univ. Prof. Dr. med. Dr. h.c. R. E. Horch), University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - J P Beier
- Department of Plastic and Hand Surgery (Head: Univ. Prof. Dr. med. Dr. h.c. R. E. Horch), University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany.
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van Alphen TC, Fechner MR, Smit JM, Slooter GD, Broekhuysen CL. The laparoscopically harvested omentum as a free flap for autologous breast reconstruction. Microsurgery 2016; 37:539-545. [PMID: 27783425 DOI: 10.1002/micr.30126] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND In autologous breast reconstruction, abdominal based flaps are by far the most common choice from the wide range of free flaps available. In selected cases, a laparoscopically harvested omental free flap (LHOFF) can be used. Patient satisfaction has not been reported until now. In this article, we report our experience using LHOFF in breast reconstruction including our technique, patient satisfaction, and donor/recipient site complications. PATIENTS AND METHODS Between 2007 and 2014, six patients underwent autologous breast reconstruction with LHOFF. Four patients had undergone radical mastectomy and two patient developed prosthesis complications after lumpectomy and breast augmentation. The omentum was harvested laparoscopically. The gastroepiploic vessels were anastomosed to the internal mammary vessels. A retrospective chart review was performed to retrieve surgical data. All the patients completed a questionnaire about their outcome. RESULTS Mean weight of the omentum was 224 g. There were no flap failures. Two patients required a second surgical procedure due to complications. In one patient, a salvage procedure was required due to a venous thrombosis, whereas in the other, there was necrosis of the skin flap. No abdominal complications or volume loss occurred. Mean follow-up was 30.5 months. The aesthetic results were very satisfactory with minimal scars and good breast volume. CONCLUSION Autologous breast reconstruction using an LHOFF can be used effectively in selected cases. The aesthetic results are pleasing with minimal scarring, good volume, and a soft, natural feeling breast.
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Affiliation(s)
- Tert C van Alphen
- Plastic Surgery, Máxima Medical Center, Veldhoven/Eindhoven, The Netherlands
| | - Maarten R Fechner
- Plastic Surgery, Máxima Medical Center, Veldhoven/Eindhoven, The Netherlands
| | - Jeroen M Smit
- Plastic Surgery, Máxima Medical Center, Veldhoven/Eindhoven, The Netherlands
| | - Gerrit D Slooter
- General Surgery, Máxima Medical Center, Veldhoven/Eindhoven, The Netherlands
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Nguyen AT, Suami H, Hanasono MM, Womack VA, Wong FC, Chang EI. Long-term outcomes of the minimally invasive free vascularized omental lymphatic flap for the treatment of lymphedema. J Surg Oncol 2016; 115:84-89. [DOI: 10.1002/jso.24379] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 07/03/2016] [Indexed: 12/23/2022]
Affiliation(s)
| | - Hiroo Suami
- Faculty of Medicine and Health Sciences; Macquarie University; Sydney Australia
| | - Matthew M. Hanasono
- Department of Plastic Surgery; University of Texas MD Anderson Cancer Center; Houston Texas
| | - Veda A. Womack
- Integrative Lymphedema Institute; Pine Creek Medical Center; Dallas Texas
| | - Franklin C. Wong
- Department of Nuclear Medicine; University of Texas MD Anderson Cancer Center; Houston Texas
| | - Edward I. Chang
- Department of Plastic Surgery; University of Texas MD Anderson Cancer Center; Houston Texas
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Bruzoni M, Steinberg GK, Dutta S. Laparoscopic harvesting of omental pedicle flap for cerebral revascularization in children with moyamoya disease. J Pediatr Surg 2016; 51:592-7. [PMID: 26611331 DOI: 10.1016/j.jpedsurg.2015.10.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 10/07/2015] [Accepted: 10/11/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION An abundance of angiogenic and immunologic factors makes the omentum an ideal tissue for reconstruction and revascularization of a variety of extraperitoneal wounds and defects. Omental harvesting was historically performed through a large laparotomy and subcutaneous tunneling to the site of disease. Several complications of the open procedure including abdominal wound infection, fascial dehiscence, ventral hernia, and postoperative ileus have been described. The use of laparoscopy to harvest the omentum has the potential to reduce such complications. We describe the surgical technique and outcomes of a series of patients undergoing laparoscopic pedicled omental flap mobilization for cerebral revascularization in moyamoya disease. METHODS A retrospective chart review of all patients undergoing laparoscopic omental cerebral transposition for moyamoya disease between 2011 and 2014 was performed. Clinical indication, surgical technique, operative times, complications, and outcomes at follow-up were reviewed. RESULTS A total of 7 children underwent the procedure. The general surgery team performed laparoscopic omental mobilization, extraperitonealization, and subcutaneous tunneling, while the neurosurgical team performed craniotomy and cerebral application of the graft. The patients were followed postoperatively with clinic visits and angiography. There was one intraoperative complication (colon injury) and one postoperative complication (intermittent omental hernia at fascial defect for pedicle). All patients had partial to complete symptomatic resolution and demonstrated adequate intracranial revascularization on angiography. CONCLUSION Laparoscopic omental pedicle flap mobilization and subcutaneous transposition is feasible in children who require salvage cerebral revascularization for moyamoya disease. The procedure should be considered for other conditions requiring extraperitoneal revascularization.
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Affiliation(s)
- Matias Bruzoni
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - Gary K Steinberg
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Sanjeev Dutta
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA.
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Dast S, Assaf N, Dessena L, Almousawi H, Herlin C, Berna P, Sinna R. Change of paradigm in thoracic radionecrosis management. ANN CHIR PLAST ESTH 2016; 61:200-5. [PMID: 26831037 DOI: 10.1016/j.anplas.2015.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 12/19/2015] [Indexed: 11/26/2022]
Abstract
Classically, muscular or omental flaps are the gold standard in the management of thoracic defects following radionecrosis debridement. Their vascular supply and antibacterial property was supposed to enhance healing compared with cutaneous flaps. The evolution of reconstructive surgery allowed us to challenge this dogma. Therefore, we present five consecutive cases of thoracic radionecrosis reconstructed with cutaneous perforator flaps. In four patients, we performed a free deep inferior epigastric perforator (DIEP) flap and one patient had a thoracodorsal perforator (TDAP) flap. Median time healing was 22.6 days with satisfactory cutaneous covering and good aesthetic results. There were no flap necrosis, no donor site complications. We believe that perforator flaps are a new alternative, reliable and elegant option that questions the dogma of muscular flaps in the management of thoracic radionecrosis.
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Affiliation(s)
- S Dast
- Department of Plastic, Reconstructive and Aesthetic surgery, Amiens Picardie University, place Victor-Pauchet, 80054 Amiens, France
| | - N Assaf
- Department of Plastic, Reconstructive and Aesthetic surgery, Amiens Picardie University, place Victor-Pauchet, 80054 Amiens, France
| | - L Dessena
- Department of Plastic, Reconstructive and Aesthetic surgery, Amiens Picardie University, place Victor-Pauchet, 80054 Amiens, France
| | - H Almousawi
- Department of Plastic, Reconstructive and Aesthetic surgery, Amiens Picardie University, place Victor-Pauchet, 80054 Amiens, France
| | - C Herlin
- Department of Plastic, Reconstructive and Aesthetic surgery, Amiens Picardie University, place Victor-Pauchet, 80054 Amiens, France
| | - P Berna
- Department of Plastic, Reconstructive and Aesthetic surgery, Amiens Picardie University, place Victor-Pauchet, 80054 Amiens, France
| | - R Sinna
- Department of Plastic, Reconstructive and Aesthetic surgery, Amiens Picardie University, place Victor-Pauchet, 80054 Amiens, France.
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Huyghe S, de Rooster H, Doom M, Van den Broeck W. The Microscopic Structure of the Omentum in Healthy Dogs: The Mystery Unravelled. Anat Histol Embryol 2015. [PMID: 26201371 DOI: 10.1111/ahe.12189] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The canine omentum has many valuable properties but is still an underestimated organ. It contributes in many ways to the protection of the peritoneal cavity through its versatility on immunological level, but also through its role during angiogenesis, absorption, adhesion and fat storage. Despite a wide range of applications, the basic structure of the omentum is not well documented. This study provides an insight in the microscopic structure of the canine omentum through both light microscopic and electron microscopic investigations. Two regions could be distinguished in the canine omentum: translucent and adipose-rich regions. The translucent regions were composed of two different layers: a continuous flattened mesothelium on top of a submesothelial connective tissue matrix. The adipose-rich regions consisted of a substantial layer of adipocytes on which a flattened continuous mesothelium was present. Between those two layers, a few strands of collagen fibres could be detected. Large aggregates of immune cells, the so-called milky spots, were not observed in the omentum of healthy dogs. Only a limited number of leucocytes, macrophages and neutrophils were found, scattered throughout the connective tissue in the translucent regions. At the level of the adipose-rich regions, the immunological population was virtually non-existent.
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Affiliation(s)
- S Huyghe
- Department of Medicine and Clinical Biology of Small Animals, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - H de Rooster
- Department of Medicine and Clinical Biology of Small Animals, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - M Doom
- Department of Morphology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - W Van den Broeck
- Department of Morphology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
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D'Angelo A, Bhama JK, Crespo M, Pilewski J, Shigemura N, Bermudez C, Luketich JD, D'Cunha J. Bronchopleural fistula after bilateral sequential lobar lung transplantation: Technical details of a successful repair. J Thorac Cardiovasc Surg 2015; 149:e67-8. [PMID: 25619804 DOI: 10.1016/j.jtcvs.2014.12.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 12/08/2014] [Accepted: 12/12/2014] [Indexed: 12/01/2022]
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Hagopian TM, Ghareeb PA, Arslanian BH, Moosavi BL, Carlson GW. Breast necrosis secondary to vasopressor extravasation: management using indocyanine green angiography and omental flap closure. Breast J 2015; 21:185-8. [PMID: 25639475 DOI: 10.1111/tbj.12379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Extravasation is a rare but serious complication of vasopressor administration. A 60-year-old female who underwent ascending and hemiarch repair of the aorta along with aortic valve replacement developed extensive right breast and chest wall necrosis after vasopressor extravasation from an internal jugular vein central line. The patient underwent a total mastectomy due to deep tissue necrosis detected by laser-assisted indocyanine green dye angiography, and eventually required omental flap reconstruction to obtain adequate sternal coverage. This case represents a previously unreported complication of internal jugular central line extravasation of vasopressors with resultant breast and chest wall necrosis, and highlights the utility of the omentum in chest wall reconstruction.
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Affiliation(s)
- Thomas M Hagopian
- Division of Plastic Surgery, Emory University School of Medicine, Atlanta, Georgia
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Doom M, de Rooster H, van Bergen T, Gielen I, Kromhout K, Simoens P, Cornillie P. Morphology of the Canine Omentum Part 1: Arterial Landmarks that Define the Omentum. Anat Histol Embryol 2014; 45:37-43. [PMID: 25516017 DOI: 10.1111/ahe.12168] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 11/04/2014] [Indexed: 11/27/2022]
Abstract
Although the omentum remains an enigmatic organ, research during the last decades has revealed its fascinating functions including fat storage, fluid drainage, immune activity, angiogenesis and adhesion. While clinicians both in human and veterinary medicine are continuously exploring new potential omental applications, detailed anatomical data on the canine omentum are currently lacking, and information is often retrieved from human medicine. In this study, the topographic anatomy of the canine greater and lesser omentum is explored in depth. Current nomenclature is challenged, and a more detailed terminology is proposed. Consistent arteries that are contained within folds of the superficial omental wall are documented, described and named, as they can provide the anatomical landmarks that are necessary for unambiguous scientific communication on the canine omentum. In an included dissection video, the conclusions and in situ findings described in this study are demonstrated.
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Affiliation(s)
- M Doom
- Department of Morphology, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - H de Rooster
- Department of Medicine and Clinical Biology of Small Animals, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - T van Bergen
- Department of Surgery and Anaesthesiology, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - I Gielen
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - K Kromhout
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - P Simoens
- Department of Morphology, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - P Cornillie
- Department of Morphology, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
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Musters GD, Sloothaak DAM, Roodbeen S, van Geloven AAW, Bemelman WA, Tanis PJ. Perineal wound healing after abdominoperineal resection for rectal cancer: a two-centre experience in the era of intensified oncological treatment. Int J Colorectal Dis 2014; 29:1151-7. [PMID: 25064389 DOI: 10.1007/s00384-014-1967-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE Intensified treatment for distal rectal cancer has improved oncological outcome, but at the expense of more perineal wound complications in patients undergoing an abdominoperineal resection (APR). The aim of this study was to analyse perineal wound healing after APR with primary perineal wound closure over time. METHOD All patients undergoing APR for primary rectal cancer with primary wound closure between 2000 and 2013 were included and analysed in three consecutive time periods. Both early (<30 days postoperatively) and late perineal wound complications were determined. Independent risk factors of early perineal wound complications were identified using multivariable analysis. RESULTS A total of 136 patients were identified, of whom 129 patients underwent primary perineal wound closure. The use of neo-adjuvant (chemo)radiotherapy increased from 72 to 91%, and the use of an extralevator approach increased from 9 to 19%. The rate of early perineal wound complications increased from 18 to 31% and was independently associated with an extralevator approach [odds ratio (OR) 3.17; 95% confidence interval (CI) 1.16-8.66] and intra-operative perforation (OR 3.35; 95% CI 1.06-10.57). Perineal wound complications had no impact on local recurrence or 3-year overall survival rate. During a median follow-up of 28 months [interquartile range (IQR) 14-56], a persistent presacral sinus was diagnosed in 10%, and a perineal hernia occurred in 8% of the patients. CONCLUSION The increased use of an extralevator APR for rectal cancer significantly increased the risk of perineal wound complications over time. Intra-operative perforation was also independently associated with impaired perineal wound healing.
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Affiliation(s)
- Gijsbert D Musters
- Department of Surgery, Academic Medical Centre, University of Amsterdam, G4, Post Box 22660, 1105 AZ, Amsterdam, The Netherlands
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Muñoz Muñoz E, Pardo Aranda F, Camps Lasa J, Rodriguez Alsina X, Veloso Veloso E. Repair of large abdominal wall defects by epiploplasty and polypropelene mesh in patients with decompressive laparostomies. Cir Esp 2014; 93:204-6. [PMID: 24709076 DOI: 10.1016/j.ciresp.2014.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 01/29/2014] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Emilio Muñoz Muñoz
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Mutua Terrassa, Terrassa, Barcelona, España
| | - Fernando Pardo Aranda
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Mutua Terrassa, Terrassa, Barcelona, España.
| | - Judith Camps Lasa
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Mutua Terrassa, Terrassa, Barcelona, España
| | - Xavier Rodriguez Alsina
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Mutua Terrassa, Terrassa, Barcelona, España
| | - Enrique Veloso Veloso
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Mutua Terrassa, Terrassa, Barcelona, España
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Iglesias M, Butrón P, León-López DA, García-Mancilla S, Espino-Gaucin I, Rubio A. Soft tissue reconstruction with omental free flap in complex upper extremity injuries: Report of 13 cases. Microsurgery 2014; 34:425-33. [DOI: 10.1002/micr.22236] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 01/16/2014] [Accepted: 01/24/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Martin Iglesias
- Plastic Surgery Service; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Mexico City Mexico
| | - Patricia Butrón
- Plastic Surgery Service; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Mexico City Mexico
| | - Daniela Alejandra León-López
- Plastic Surgery Service; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Mexico City Mexico
| | - Sofía García-Mancilla
- Plastic Surgery Service; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Mexico City Mexico
| | - Israel Espino-Gaucin
- Plastic Surgery Service; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Mexico City Mexico
| | - Alethia Rubio
- Plastic Surgery Service; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Mexico City Mexico
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Zhong T, Gullane P, Neligan P. Bilateral latissimus dorsi flaps for the reconstruction of extensive scalp defects. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2013; 11:79-82. [PMID: 24222989 DOI: 10.1177/229255030301100201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The reconstruction of large scalp defects is occasionally required. Several methods of scalp reconstruction have previously been described. This paper presents the authors' experience with two patients in whom traditional methods were not sufficient and in whom bilateral latissimus dorsi free flaps were required. OBJECTIVES To evaluate the effectiveness of a new technique in reconstructing extensive scalp defects. METHODS Two case histories are presented. These include the rationale for the choice of reconstruction used as well as a discussion on the technical features of the surgery. RESULTS Reconstruction was effective in both cases. However, one patient died in the early postoperative period from a pulmonary embolus. CONCLUSIONS Bilateral latissimus flaps can be safely and effectively used in closing massive scalp defects in selected cases.
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Affiliation(s)
- T Zhong
- Wharton Head and Neck Program, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario
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41
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Transdiaphragmatic omental harvest: a simple, efficient method for sternal wound coverage. Plast Reconstr Surg 2013; 131:544-552. [PMID: 23142938 DOI: 10.1097/prs.0b013e31827c6e2e] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The greater omentum is easily harvested for coverage of sternal wounds without muscle sacrifice. Its major disadvantage is a laparotomy incision with potential bowel injury, adhesions, or hernia. Over the past 20 years, the authors' technique has evolved to use a transdiaphragmatic opening for omental harvest when possible. METHODS The authors performed a retrospective cohort analysis of 140 consecutive patients undergoing omental flap harvest for treatment of sternal wounds following median sternotomy. Patients were divided into two groups by access incision: laparotomy incision (n = 80) versus a transdiaphragmatic opening (n = 60). RESULTS The authors found that both techniques provided reliable closure of sternal wounds, but the transdiaphragmatic approach was faster, with less blood loss. There was no significant difference in rates of ventral hernias. We had only one bowel injury (laparotomy group) and no postoperative abdominal bleeding or small bowel obstruction. CONCLUSION Transdiaphragmatic omental harvest provides safe and efficient coverage of deep sternal wounds without a laparotomy incision.
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Attash SM, Al-Sheikh MY. Omental flap for treatment of long standing lymphoedema of the lower limb: can it end the suffering? Report of four cases with review of literatures. BMJ Case Rep 2013; 2013:bcr-2012-008463. [PMID: 23396936 DOI: 10.1136/bcr-2012-008463] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report our experience of four cases of long-standing unilateral, secondary lymphoedema of the lower limb, for which conservative treatment has failed, that were treated in our centre using pedicled omental flap. The four patients were followed for a period of 1 year after the procedures and frequent measurements of the circumference of the affected limb revealed a reduction in the circumference ranging between 50% in the first patient to 75% in the fourth patient together with an excellent functional improvement in terms of resuming walking, daily activities, sports and work. We think that pedicled omental flap is an important, relatively easy and safe option that deserves consideration in refractory cases of lymphoedema of the lower limb.
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Affiliation(s)
- Saad Muwafaq Attash
- Department of Surgery, Ninava Medical College, Mosul University, Mosul, Iraq.
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Sternal reconstruction with omental and pectoralis flaps: a review of 415 consecutive cases. Ann Plast Surg 2012; 69:296-300. [PMID: 22214791 DOI: 10.1097/sap.0b013e31822af843] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Sternal wound infections are a life-threatening complication of cardiovascular surgery, and management can present a great challenge for the plastic surgeon. Successful treatment involves a multidisciplinary approach, immediate detection, meticulous debridement, and delivery of vascularized tissue to the infected wound bed. METHODS Twenty-nine years experience of a single surgeon in 415 sternal wound reconstructions is retrospectively analyzed. Flap choice was based on the amount of vascularized tissue required. Low-risk, early infections were treated with debridement and a single flap. Large, high-risk wounds were treated with multiple debridements and covered with a combination of flaps to reduce infection and eliminate dead space. RESULTS Immediate wound closure with aggressive debridement and flap coverage in a single-stage early in the series (first 12 patients, 1980-1981) led to a mortality rate of 25% due to sepsis and cardiovascular instability. Thereafter, treatment was altered, and patient stability and wound preparation were emphasized, often requiring multiple debridements (91% of all patients). Nine percent of patients, with early low-risk infections, underwent single-stage rewiring and coverage with pectoralis or omental flaps. Coverage of multiple debrided purulent wounds was performed using pectoralis major flap (37% of total number of patients), omentum (18%), a pectoralis/omentum combination (34%), or rectus abdominis flap (2%). A multistage approach and use of 2 flaps for coverage resulted in a 1.5% mortality due to sepsis, 2.5% infection rate, 1.5% skin necrosis rate, and 1.5% hematoma/seroma rate. The use of multiple flaps in large, complex wounds resulted in a complication rate similar to smaller wounds covered with a single flap. In all, 3.5% of the patients required a salvage operation with alternate flaps. CONCLUSION This large series demonstrates the importance of early detection of infection, meticulous staged debridement of nonviable tissue, and elimination of dead space with multiple vascularized flaps.
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Use of the omental free flap for reconstruction of degloving hand and foot injuries: two case reports. Open Med (Wars) 2012. [DOI: 10.2478/s11536-012-0075-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractDifferent techniques are used for reconstruction of degloving hand or foot injuries, however the best option has not been found yet. In this paper we present two clinical cases when degloving hand and foot injuries were successfully covered with the omental free flap.
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Abstract
The omentum, external oblique musculocutaneous, and thoracoepigastric flaps are uncommonly used for chest wall reconstruction. Nevertheless, awareness and knowledge of these flaps is essential for reconstructive surgeons because they fill specific niche indications or serve as lifeboats when workhorse flaps are unavailable. The current report describes the anatomic basis, technical aspects of flap elevation, and indications for these unusual flaps.
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Affiliation(s)
- Evan Matros
- Division of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
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Parissis H, Al-Alao B, Soo A, Orr D, Young V. Risk analysis and outcome of mediastinal wound and deep mediastinal wound infections with specific emphasis to omental transposition. J Cardiothorac Surg 2011; 6:111. [PMID: 21923951 PMCID: PMC3182890 DOI: 10.1186/1749-8090-6-111] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 09/19/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To report our experience, with Deep mediastinal wound infections (DMWI). Emphasis was given to the management of deep infections with omental flaps METHODS From February 2000 to October 2007, out of 3896 cardiac surgery patients (prospective data collection) 120 pts (3.02%) developed sternal wound infections. There were 104 males & 16 females; (73.7%) CABG, (13.5%) Valves & (9.32%) CABG and Valve. RESULTS Superficial sternal wound infection detected in 68 patients (1.75%) and fifty-two patients (1.34%) developed DMWI. The incremental risk factors for development of DMWI were: Diabetes (OR = 3.62, CI = 1.2-10.98), Pre Op Creatinine > 200 μmol/l (OR = 3.33, CI = 1.14-9.7) and Prolong ventilation (OR = 4.16, CI = 1.73-9.98). Overall mortality for the DMWI was 9.3% and the specific mortality of the omental flap group was 8.3%. 19% of the "DMWI group", developed complications: hematoma 6%, partial flap loss 3.0%, wound dehiscence 5.3%. Mean Hospital Stay: 59 ± 21.5 days. CONCLUSION Post cardiac surgery sternal wound complications remain challenging. The role of multidisciplinary approach is fundamental, as is the importance of an aggressive early wound exploration especially for deep sternal infections.
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Affiliation(s)
- Haralabos Parissis
- Cardiothoracic Department, Royal Victoria Hospital, Grosvenor Rd, Belfast, BT12 6BA, UK.
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Schols RM, Lauwers TMAS, Geskes GG, van der Hulst RRWJ. Deep sternal wound infection after open heart surgery: current treatment insights. A retrospective study of 36 cases. EUROPEAN JOURNAL OF PLASTIC SURGERY 2011; 34:487-492. [PMID: 22162911 PMCID: PMC3218281 DOI: 10.1007/s00238-011-0573-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 03/16/2011] [Indexed: 12/16/2022]
Abstract
The aim of this study was to retrospectively evaluate the results of reconstructing infected post-sternotomy wounds, with either sternal plating and/or pectoralis major flap transposition or pedicled omentoplasty after previous vacuum-assisted closure (VAC) therapy. Between January 2005 and December 2010, 36 patients, suffering from deep sternal wound infection (DSWI) after coronary artery bypass grafting procedure, received (plastic) reconstructive surgery. All patients, treated in the Maastricht University Medical Centre (Departments of Plastic Surgery and Cardiothoracic Surgery), were selected for this study. For 22 patients, sternal refixation and reconstruction were obtained by sternal internal plate fixation combined with bilateral pectoralis major advancement flap. In 11 patients, a pedicled omentoplasty was performed, with or without split-skin graft and additional VAC therapy. Three patients only received a pectoralis plasty. We evaluated preoperative characteristics and post-operative course. Twenty-four patients (66.7%) had an uneventful post-operative course. Complications in the other patients included wound dehiscence, herniation of the donor site and infection of sternal plating material. Average sternal wound healing after sternal plating plus pectoralis plasty, pectoralis plasty and omentoplasty respectively accounted 7.7, 8.0 and 11.6 weeks. From our experience, we recommend VAC therapy plus delayed sternal plating and additional bilateral pectoralis major flap advancement as first repair option in case of DSWI. However, individual clinical conditions need to be taken into account when making a decision between the different available reconstructive options. Omentoplasty should be reserved for cases in which the sternum has recurrently fallen open after previous sternal plate refixation, or for cases in which the sternum defect is too extended.
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Affiliation(s)
- Rutger M. Schols
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Thomas M. A. S. Lauwers
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Gijs G. Geskes
- Department of Cardiothoracic Surgery, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - René R. W. J. van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands
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Mayer HF, Diodato LH, Sanchez RJ, Loustau HD, Sarrabayrouse M, Bracco DA. New method of tunnelling for omental transposition in the treatment of a complex radionecrotic groin ulcer. J Plast Surg Hand Surg 2010; 44:178-80. [PMID: 20158431 DOI: 10.3109/02844310802271121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Omental transposition is often used for reconstruction of soft tissue in the groin. However, the potential for incisional hernia is a relative contraindication. We report the cure of a groin ulcer with omental transposition using a new method of tunnelling to avoid herniation.
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Affiliation(s)
- Horacio F Mayer
- Department of Plastic Surgery, Hospital Italiano de Buenos Aires, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
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Utility of the omentum in pelvic floor reconstruction following resection of anorectal malignancy: patient selection, technical caveats, and clinical outcomes. Ann Plast Surg 2010; 64:559-62. [PMID: 20395804 DOI: 10.1097/sap.0b013e3181ce3947] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study assesses the usefulness of the omentum in the reconstruction of complex perineal defects, following abdominoperineal resection or pelvic exenteration, for anorectal malignancy. Between 2000 and 2008, 70 patients (mean age: 59 years) with anorectal malignancy underwent abdominoperineal resection (n = 57) or pelvic exenteration (n = 13) and were reconstructed by primary repair alone (n = 13), primary repair with omentum (n = 16), myocutaneous flap alone (n = 28), or myocutaneous flap with omentum (n = 13). Patients with and without omental flaps were compared by Student t test and chi2 analysis. Omental flaps were based on a single pedicle, tunneled in the retrocolic plane lateral to the ligament of Treitz, and transposed across the sacrum to the pelvic floor. In total, 29 patients had pelvic floor and perineal reconstruction with the omentum, and 41 patients had reconstruction without the omentum. Incidence of major pelvic complications (abscess, urinoma, deep vein thrombosis, flap dehiscence, hernia, bowel obstruction, fistula) was greater in the "no omentum" group (25/41 patients, 61%), compared with the "omentum" group (6/29 patients, 21%) (P < 0.01). No differences were observed regarding age, stage, incidence of radiotherapy, blood loss, length of stay, or mortality. Use of the omentum as a primary flap, or in combination with a myocutaneous flap, in the reconstruction of complex perineal defects, is associated with a decreased incidence of postoperative complications, strongly supporting the use of the omentum in pelvic floor reconstruction.
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Hollinger L, Perryman L, Reardon MJ. Endocarditis with left ventricular cutaneous fistula after aortic root replacement with a valved conduit. Tex Heart Inst J 2010; 37:230-233. [PMID: 20401302 PMCID: PMC2851426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Infection after aortic root replacement is uncommon, and it can be fatal. Herein, we present the case of a patient who underwent aortic root replacement with a valved conduit and coronary reimplantation. Prosthetic valve endocarditis and left ventricular cutaneous fistula ensued. Either condition alone could have been fatal. The fistula coursed from the valved conduit through the left ventricular outflow tract, behind the left main coronary artery, and to the skin at the upper sternum. Safe surgical entry into the chest was crucial, due to the free communication between the left ventricle, mediastinum, and skin. We discuss our surgical approach to this unusual combination of conditions, and the postoperative treatment of the patient.
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Affiliation(s)
- Laura Hollinger
- Department of Cardiac Surgery, The Methodist Hospital, Houston, Texas 77030, USA
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