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Liu H, He X, Li L, Wan NB. Laparoscopically harvested omental flap for immediate breast reconstruction: a retrospective single-center study of 300 cases. World J Surg Oncol 2024; 22:97. [PMID: 38622606 PMCID: PMC11020457 DOI: 10.1186/s12957-024-03377-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/29/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The laparoscopically harvested omental flap (LHOF) has been used in partial or total breast reconstruction, but most studies on LHOF were case reports or small case series. However, the clinical feasibility and oncological safety of LHOF in oncoplastic breast surgery remains controversial. This study reported our experience applying LHOF for immediate breast reconstruction. METHODS Between June 2018 and March 2022, 300 patients underwent oncoplastic breast surgery using LHOF at our institution. Their clinicopathological data, complications, cosmetic outcomes, and oncologic outcomes were evaluated. RESULTS All patients underwent total breast reconstruction using LHOF after nipple-sparing mastectomy. The median operation time was 230 min (ranging from 155 to 375 min). The median operation time for harvesting the omental flap was 55 min (ranging from 40 to 105 min). The success rate of the laparoscopically harvested pedicled omental flap was over 99.0%. Median blood loss was 70 ml, ranging from 40 to 150 ml. The volume of the flap was insufficient in 102 patients (34.0%). The overall complication rate was 12.3%. Subcutaneous fluid in the breast area (7%) was the most common reconstruction-associated complication, but most cases were relieved spontaneously. The incidence rate of omental flap necrosis was 3.3%. LHOF-associated complications occurred in two cases, including one case of incisional hernia and one case of vascular injury. Cosmetic outcomes were satisfactory in 95.1% of patients on a four-point scale by three-panel assessment and 97.2% using the BCCT.core software. Two local and one systemic recurrence were observed during a median follow-up period of 32 months. CONCLUSIONS The LHOF for immediate breast reconstruction is a safe and feasible method that involves minimal donor-site morbidity, satisfactory cosmetic outcomes, and promising oncologic safety.
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Affiliation(s)
- Hao Liu
- The Second Department of Breast Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China.
| | - Xiao He
- The Second Department of Breast Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Li Li
- The Second Department of Breast Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Neng-Bin Wan
- The Second Department of Breast Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
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Doersch KM, Li KA, Ajay D. Flaps and Grafts in Robotic Reconstructive Surgery. Curr Urol Rep 2024:10.1007/s11934-024-01201-z. [PMID: 38514479 DOI: 10.1007/s11934-024-01201-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE OF REVIEW The robotic approach is increasingly popular in reconstructive urology. Reconstructive surgeons have commonly used flaps and grafts for obliterating dead space including tissue interposition or as an alternative to mesh in addressing lower urinary tract dysfunction. Advantages of the robotic approach are less incisional pain, excellent visualization in the deep pelvis, and improved surgeon ergonomics. In this literature review, we describe flaps and grafts used in lower urinary tract robotic reconstructive urology, serving as an almanac for these techniques. RECENT FINDINGS Omental, peritoneal, vertical rectus abdominis musculocutaneous (VRAM), sigmoid epiploica, gracilis flaps, and Alloderm™ have been reported for tissue interposition during fistula repair. Fascia lata has been described as a mesh alternative for robotic sacrocolpopexy. Besides providing interposition, flaps support native tissue healing and blood supply. Grafts are easy to use with low patient morbidity, but rely on the blood supply at the recipient site. Robotic reconstruction is an emerging field, and more studies are needed to define the best uses for each flap and graft as well as strategies to maximize outcomes and minimize morbidity.
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Affiliation(s)
- Karen M Doersch
- Department of Urology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 656, Rochester, NY 14610, USA.
| | - Kathleen A Li
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Divya Ajay
- Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Shen G, Yang Y, Huang M, Ding X, Li N, Yu X. Immediate breast reconstruction with laparoscopically harvested omental flap: A retrospective analysis with a maximum 12-year follow-up. Surg Today 2024; 54:186-194. [PMID: 37516998 DOI: 10.1007/s00595-023-02718-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/29/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE To evaluate the clinical efficacy of immediate breast reconstruction with free or pedicled laparoscopically harvested omental flaps (LHOFs). METHODS Between March 2011 and 2021, 82 patients who underwent immediate breast reconstruction with free or pediculated omental flaps were enrolled. Breast total or partial mastectomy, laparoscopic greater omentum harvest, and breast reconstruction were carried out in an orderly manner. Postoperative operative results, cosmetic outcomes, and complications were investigated. RESULTS Seventeen cases of free LHOF and 65 cases of pedicled LHOF were performed. Cosmetic results were mostly satisfactory (61% excellent, 35% good), with a soft breast that was natural in appearance. Satisfaction investigation showed that 96.2% of patients were satisfied with the reconstructed breast. Uneventful follow-up showed no abdominal complications at the donor site, and the surface skin displayed no swelling. No major complications were found, except for three cases of necrosis. One patient developed slight hematoma. Two patients were found to have local recurrence, and one had distant metastasis. Twenty-four patients accepted radiotherapy, but no size reduction was noted after radiotherapy. We followed the patients to determine their survival status. All patients were alive, except for 1 in the free LHOF group who died 31.2 months after surgery. CONCLUSION Immediate breast reconstruction with LHOF provides a soft reconstructed breast with relatively little donor-site deformity and is useful for breast tumor-specific immediate reconstruction.
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Affiliation(s)
- Guangtai Shen
- Department of Thyroid and Breast Surgery, Xinganmeng People's Hospital, Inner Mongolia Autonomous Region, Ulanhot, 137400, People's Republic of China
| | - Yuqing Yang
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, 127 Changle West Road, Xi'an, Shaanxi, 710032, People's Republic of China
| | - Meiling Huang
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, 127 Changle West Road, Xi'an, Shaanxi, 710032, People's Republic of China
| | - Xiaoli Ding
- Department of Thyroid and Breast Surgery, Xinganmeng People's Hospital, Inner Mongolia Autonomous Region, Ulanhot, 137400, People's Republic of China
| | - Nanlin Li
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, 127 Changle West Road, Xi'an, Shaanxi, 710032, People's Republic of China.
| | - Xiaoqiang Yu
- Department of Thyroid and Breast Surgery, Xinganmeng People's Hospital, Inner Mongolia Autonomous Region, Ulanhot, 137400, People's Republic of China.
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4
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Karmiris NI, Albanis Z, Zafeirakis A, Vezakis A, Konstadoulakis M, Fragulidis GP. The increased angiogenic capacity and decreased inflammatory response when a mesh is used in combination with an omental flap. A prospective experimental study. J Plast Reconstr Aesthet Surg 2023; 86:261-268. [PMID: 37793199 DOI: 10.1016/j.bjps.2023.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 08/30/2023] [Accepted: 09/08/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND The use of a surgical mesh for abdominal wall reconstruction is well established and has been used for long with minor complications, whereas the omental flap has been used for decades in reconstructive surgery. AIM To demonstrate the increased angiogenic capacity and the reduced inflammatory markers of a synthetic mesh when used in combination with an omental flap. Furthermore, we compare two independent meshes when used alone or in combination with the omental flap. MATERIALS AND METHODS Twenty-eight rats were included in the study. To determine the effect of using an omental flap under two different meshes, the animals were separated into four groups, i.e., group A (flap + mesh 1), group B (flap + mesh 1 + silicone), group C (flap + mesh 2), and group D (flap + mesh 2 + silicone). A silicone sheet was placed as a barrier between the mesh and the flap. All groups were sacrificed 8 weeks post-operatively. RESULTS The use of a silicone sheet barrier between any of the two synthetic meshes and the omental flap in an abdominal wall defect is accompanied by a markedly reduced angiogenesis in terms of a cluster of differentiation (CD)-34 (p < 0.001) and factor VIII (p = 0.0012) and by increased inflammatory response CD-68 (p = 0.0024) and visual scoring (p < 0.001). CONCLUSIONS Τhe increased angiogenic capacity and the reduced inflammatory markers of a synthetic surgical mesh when used in combination with an omental flap make it a useful option in the reconstruction of an abdominal wall defect on a large or contaminated wound.
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Affiliation(s)
- N I Karmiris
- Plastic Surgery Department, 401 General Army Hospital, Athens, Greece.
| | - Z Albanis
- Histopathology Department, 251 General Air Force Hospital, Athens, Greece
| | - A Zafeirakis
- Department of Nuclear Medicine, 417 Army Share Fund Hospital, Athens, Greece
| | - A Vezakis
- 2nd Department of Surgery, Aretaieio Hospital, Athens, Greece
| | | | - G P Fragulidis
- 2nd Department of Surgery, Aretaieio Hospital, Athens, Greece
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Otieno DO, Malik J, Wabwire B. Pediatric patient with a complex Abdominal Wall defect reconstructed with sandwich omental flap. A case report. Int J Surg Case Rep 2023; 109:108512. [PMID: 37478702 PMCID: PMC10375844 DOI: 10.1016/j.ijscr.2023.108512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/12/2023] [Accepted: 07/16/2023] [Indexed: 07/23/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Low grade Fibromyxoid sarcoma (LGFMS) is a rare soft tissue sarcoma. LGFMS has an indolent clinical behavior but it is prone for late local recurrence and metastasis. In children it is commonly seen in the subcutaneous tissues relative to adults where it presents in deep soft tissues. These patients are best managed in a specialized unit with a multidisciplinary team. For patients with sarcoma, wide local excision remains the treatment of choice. Large complex abdominal wall defects present a unique reconstructive challenge to the surgeon following tumor removal. CASE PRESENTATION Here, we present a case of a 9-year old pediatric male patient with complex abdominal wall defect post excision of a recurrent fibromyxoid sarcoma, reconstructed with a sandwich omental flap, monofilament polypropylene mesh (Bard® Mesh) and split-thickness skin graft (STSG). CLINICAL DISCUSSION Despite the success of covering the defect, the patient still had quite a bit of morbidity with the following:abdominal hernia defect and tumor recurrence. Our case demonstrates the diagnostic and therapeutic challenges in management of sarcomas hence the need for these patients to be managed through a multidisciplinary approach. CONCLUSION The omental flap is quite versatile, and knowing how to raise it does not require sophisticated microsurgical skills. It adds to the reconstructive surgeon's armamentarium, especially in resource-limited settings.
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Affiliation(s)
- Daniel Odhiambo Otieno
- Department of Plastic, Reconstructive and Aesthetic Surgery University of Nairobi School of Medicine, Nairobi, Kenya.
| | - Janan Malik
- Department of Plastic, Reconstructive and Aesthetic Surgery University of Nairobi School of Medicine, Nairobi, Kenya
| | - Benjamin Wabwire
- Department of Plastic, Reconstructive and Aesthetic Surgery Kenyatta National Hospital, Nairobi, Kenya
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Kuhara Y, Hotei H, Hashimoto T, Seo S, Amioka A, Murao N, Kuwada A, Nakashima A, Sakabe R, Tahara K. Successful omental flap coverage repair of a rectovaginal fistula after low anterior resection: a case report. Surg Case Rep 2023; 9:61. [PMID: 37071261 PMCID: PMC10113401 DOI: 10.1186/s40792-023-01642-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/10/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Rectovaginal fistula (RVF) is a troublesome and refractory complication after low anterior resection (LAR) for rectal cancer. An omental flap repair was performed for the RVF caused due to Crohn's disease and childbirth trauma. However, there are few cases of an omental flap repair for RVF after LAR. Herein, we present a successfully repaired case of RVF by omental flap coverage after LAR for rectal cancer. CASE PRESENTATION A 50-year-old female patient with advanced rectal cancer underwent laparoscopic LAR with double-stapling technique anastomosis and achieved curative resection. She complained of a stool from the vagina and was diagnosed with RVF on the postoperative day (POD) 18. Conservative therapy was ineffective. We performed laparoscopic fistula resection and direct closure of the vagina and rectum, designed the omentum that could reach the pelvis, repaired RVF by omental flap coverage, and performed transverse colostomy on POD 25. She was discharged on initial POD 48. Seven months after the initial operation, colostomy closure was administered. There was no recurrence of RVF found 1 year after the initial operation. CONCLUSIONS The patient achieved an omental flap coverage for RVF. We successfully performed the omental flap coverage repair in patients with RVF after the leakage of LAR. An omental flap may become an alternative treatment for muscle flap or an effective treatment for RVF.
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Affiliation(s)
- Yuta Kuhara
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan.
| | - Hiroshi Hotei
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan
| | - Tatsunori Hashimoto
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan
| | - Shingo Seo
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan
| | - Ai Amioka
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan
| | - Naoki Murao
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan
| | - Aki Kuwada
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan
| | - Akira Nakashima
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan
| | - Ryutaro Sakabe
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan
| | - Kou Tahara
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan
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Alshammasi ZH, Boumarah DN, AlAbbad A, Alkhalifa AA, Sahwan A, Alshomimi S. Reconstruction of Infected Mediastinal Wound with an Omental Flap Harvested Laparoscopically After Cardiac Surgery: Report of Two Cases and Literature Review. Med Arch 2023; 77:241-244. [PMID: 37700924 PMCID: PMC10495153 DOI: 10.5455/medarh.2023.77.241-244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/05/2023] [Indexed: 09/14/2023] Open
Abstract
Background Deep sternal wound infection and dehiscence are two serious complications after open cardiac surgery. Omental flap harvesting is recognized as one of the management options, with traditionally non-favorable outcomes due to laparotomy stress on patients. Objective Herein, however, we report our experience with two patients who have developed a mediastinal wound infection following coronary artery bypass grafting and were reconstructed with omental flaps harvested laparoscopically. Case Presentation Two 74-year-old females, who were known to have multiple comorbidities, developed a sternal wound infection after coronary artery bypass graft. Several operative trials and non-operative measures have been attempted to manage the infections and/or reconstruct the wound but failed. Both patients then underwent laparoscopic omental flap harvesting for reconstruction and exhibited significant clinical improvement postoperatively. Discussion Omental flap is considered a feasible option for reconstruction of sternal wound dehiscence developing after open cardiac surgery because it is usually well-vascularized, contains a large number of immunologically active cells and has the ability to absorb wound secretions. The traditional method of harvesting is conventional laparotomy, but it carries high rates of morbidity. Therefore, laparoscopic harvesting can be utilized as an alternative with better outcomes. Conclusion Laparoscopic omental flap harvesting is considered a feasible and safe procedure to manage sternal wound dehiscence after open cardiac surgery, with satisfactory surgical outcomes.
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Affiliation(s)
- Zahra H Alshammasi
- Department of Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Dhuha N Boumarah
- Department of Surgery, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Aqilah AlAbbad
- Department of Surgery, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Ahmed A Alkhalifa
- Department of Surgery, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Abdullah Sahwan
- Department of Surgery, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Saeed Alshomimi
- Department of Surgery, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
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Zaha H, Abe N, Matsumoto H, Koki A, Unesoko M. Bilateral oncoplastic breast-conserving surgery with volume replacement technique using the omental flap: a case report. Surg Case Rep 2022; 8:90. [PMID: 35527296 PMCID: PMC9081072 DOI: 10.1186/s40792-022-01434-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 04/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Many oncoplastic volume replacement techniques have been reported, however, it is generally difficult to utilize a single distant flap for bilateral breast carcinomas. Case presentation We report a case of bilateral multiple breast carcinomas successfully treated with immediate volume replacement technique with an omental flap. Bilateral partial mastectomies were performed for bilateral breast carcinomas (one in the left breast and two in the right breast). The pedicled omental flap was laparoscopically harvested, and divided at the mid-portion of the flap. The proximal half of the flap was used to fill the right defect, and the distal half of the flap filled two defects in the left breast. Cosmetic outcome was excellent with minimal donor-site scars. Conclusions The omental flap can be considered for highly selected patients with bilateral breast carcinomas.
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Affiliation(s)
- Hisamitsu Zaha
- Department of Breast Surgery, Nakagami Hospital, 610 Noborikawa, Okinawa, Japan.
| | - Norie Abe
- Department of Breast Surgery, Nakagami Hospital, 610 Noborikawa, Okinawa, Japan
| | - Hirofumi Matsumoto
- Department of Pathology, Nakagami Hospital, 610 Noborikawa, Okinawa, Japan
| | - Ayako Koki
- Department of Breast Surgery, Nakagami Hospital, 610 Noborikawa, Okinawa, Japan
| | - Mikiko Unesoko
- Department of Breast Surgery, Nakagami Hospital, 610 Noborikawa, Okinawa, Japan
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Fabrizio T, Guarro G, Filippini A, La Torre G, Grieco MP. INDICATIONS FOR LIMITATIONS OF THE OMENTAL PEDICLE FLAP IN IMMEDIATE BREAST RECONSTRUCTION - SURGICAL RESULTS EVALUATION AND BREAST-Q© 2.0 SURVEY. J Plast Reconstr Aesthet Surg 2021:S1748-6815(21)00604-5. [PMID: 34930701 DOI: 10.1016/j.bjps.2021.11.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/14/2021] [Accepted: 11/11/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIM Immediate reconstruction with an omental flap is a recognized suitable method for a full-thickness breast reconstruction or implant coverage for well-selected cases of nipple or skin-sparing mastectomies as well as cases of skin-reducing mastectomies. The authors' aim is the evaluation of indications and limitations of this technique with an original approach and also based on the analysis of patients' global satisfaction using the BREAST-Q 2.0© survey. MATERIALS AND METHODS From January 2014 to March 2018, 12 women aged between 29 to 67 years old (mean age: 49 years) underwent immediate breast reconstruction alone or with a definitive implant covered by a pedicled omental flap. All of them were asked to fill out the BREAST-Q© 2.0 survey. CONCLUSIONS The careful analysis of the cases shows that the indications for the immediate breast reconstruction based on the omental flap with a minimal resulting donor-site morbidity are strictly linked to its limitations, which are correctly reported in the study, but in the same way, it suggests that patients who underwent implant-based immediate breast reconstruction with omental flap reported significant improvements in satisfaction and health-related quality of their life.
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10
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Okita Y. Need more cells and cytokine. Eur J Cardiothorac Surg 2021; 60:1051-1052. [PMID: 34329402 DOI: 10.1093/ejcts/ezab260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yutaka Okita
- Cardio-Aortic Center, Takatsuki General Hospital, Takatsuki, Osaka, Japan
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11
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Wang H, Roche CD, Gentile C. Omentum support for cardiac regeneration in ischaemic cardiomyopathy models: a systematic scoping review. Eur J Cardiothorac Surg 2021; 58:1118-1129. [PMID: 32808023 PMCID: PMC7697859 DOI: 10.1093/ejcts/ezaa205] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/06/2020] [Accepted: 05/09/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES ![]()
Preclinical in vivo studies using omental tissue as a biomaterial for myocardial regeneration are promising and have not previously been collated. We aimed to evaluate the effects of the omentum as a support for bioengineered tissue therapy for cardiac regeneration in vivo. METHODS A systematic scoping review was performed. Only English-language studies that used bioengineered cardio-regenerative tissue, omentum and ischaemic cardiomyopathy in vivo models were included. RESULTS We initially screened 1926 studies of which 17 were included in the final qualitative analysis. Among these, 11 were methodologically comparable and 6 were non-comparable. The use of the omentum improved the engraftment of bioengineered tissue by improving cell retention and reducing infarct size. Vascularization was also improved by the induction of angiogenesis in the transplanted tissue. Omentum-supported bioengineered grafts were associated with enhanced host reverse remodelling and improved haemodynamic measurements. CONCLUSIONS The omentum is a promising support for myocardial regenerative bioengineering in vivo. Future studies would benefit from more homogenous methodologies and reporting of outcomes to allow for direct comparison.
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Affiliation(s)
- Hogan Wang
- Northern Clinical School of Medicine, University of Sydney, Kolling Institute, St Leonards, Sydney, NSW, Australia
| | - Christopher D Roche
- Northern Clinical School of Medicine, University of Sydney, Kolling Institute, St Leonards, Sydney, NSW, Australia.,Department of Cardiothoracic Surgery, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia.,Department of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney (UTS), Ultimo, Sydney, NSW, Australia.,Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff, UK
| | - Carmine Gentile
- Northern Clinical School of Medicine, University of Sydney, Kolling Institute, St Leonards, Sydney, NSW, Australia.,Department of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney (UTS), Ultimo, Sydney, NSW, Australia
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12
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Shijo T, Matsuda H, Yokawa K, Inoue Y, Seike Y, Uehara K, Takahara M, Sasaki H. The impact of vascularized tissue flap coverage on aortic graft infection with and without infected graft excision. Eur J Cardiothorac Surg 2021; 60:1043-1050. [PMID: 34059918 DOI: 10.1093/ejcts/ezab179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 03/11/2021] [Accepted: 03/19/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Aortic graft infection (AGI) is a serious condition associated with a high mortality rate. However, optimal surgical options have not been identified. Therefore, we retrospectively reviewed AGI cases, including those in the thoracic and abdominal regions, with or without fistula formation, to investigate the various options for better outcomes. METHODS We reviewed 50 patients who underwent surgical interventions for AGI out of 97 patients with arterial infective disease. The mean patient age was 67 ± 17 years. Fourteen patients (28%) had a fistula with the gastrointestinal tract or lung. A combination of graft excision and vascularized tissue flap coverage was performed in 25 cases (50%). Tissue flap alone, graft excision alone and cleansing alone were performed in 9 (18%), 10 (20%), and 6 cases (12%), respectively. RESULTS Total in-hospital mortality rate was 32% (n = 16). In-hospital mortalities in patients with and without fistulas were 43% (6/14) and 28% (10/36), respectively (P = 0.33). Subgroup analysis among patients without fistula demonstrated that the in-hospital mortality rate of the patients with vascularized tissue flap (3/21, 14%) was significantly lower than that of the patients without vascularized tissue flap (7/14, 50%, P = 0.026). Overall 1- and 5-year survival rates were 66% and 46%, respectively. In multivariable analysis, an independent factor associated with in-hospital mortality was vascularized tissue flap (odds ratio 0.20, P = 0.024). CONCLUSIONS Vascularized tissue flaps could provide better outcomes for AGI. Graft preservation with vascularized tissue flaps could be a useful option for AGI without fistula.
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Affiliation(s)
- Takayuki Shijo
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Koki Yokawa
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yosuke Inoue
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshimasa Seike
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kyokun Uehara
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Sasaki
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
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Wang H, Roche CD, Gentile C. Reply to Yurekli et al. Eur J Cardiothorac Surg 2021; 60:1004-1005. [PMID: 33961021 DOI: 10.1093/ejcts/ezab152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hogan Wang
- Northern Clinical School of Medicine, University of Sydney, Kolling Institute, St Leonards, Sydney, NSW, Australia
| | - Christopher D Roche
- Northern Clinical School of Medicine, University of Sydney, Kolling Institute, St Leonards, Sydney, NSW, Australia.,Department of Cardiothoracic Surgery, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia.,School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney (UTS), Ultimo, Sydney, NSW, Australia.,Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff, UK
| | - Carmine Gentile
- Northern Clinical School of Medicine, University of Sydney, Kolling Institute, St Leonards, Sydney, NSW, Australia.,School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney (UTS), Ultimo, Sydney, NSW, Australia
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14
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Kim EK, Chae S, Ahn SH. Single-port laparoscopically harvested omental flap for immediate breast reconstruction. Breast Cancer Res Treat 2020; 184:375-384. [PMID: 32766951 DOI: 10.1007/s10549-020-05848-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/30/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Immediate breast reconstruction using laparoscopically harvested omental flap is a safe and feasible technique, providing natural contour and softness to reconstructed breasts with reduced donor-site morbidity and deformity. We report our experience using single-port laparoscopically harvested omental flap (SLOF) for immediate breast reconstruction. METHODS Between February 2015 and December 2018, 129 patients with malignant neoplasm of the breast underwent nipple-sparing mastectomy (NSM) or breast-conserving surgery (BCS) followed by immediate SLOF reconstruction at Seoul National University Bundang Hospital. We assessed their clinicopathological data, complications, and cosmetic and oncologic outcomes. Cosmetic outcomes were evaluated by three-panel assessment and the BCCT.core software program. RESULTS One hundred and six (82.2%) underwent NSM and 23 (17.8%) underwent BCS. Mean operation time was 205 (range, 134-316) minutes. Most patients had early-stage disease; 15 (11.6%) received neoadjuvant chemotherapy. Two had malignant phyllodes tumors. Cosmetic outcomes were excellent or good in 96.9% by three-panel assessment and 99.2% by the BCCT.core program with a nearly invisible donor-site scar in the umbilicus. Harvest-associated complications occurred in five (3.9%) patients, including two umbilical wound infections, one intra-abdominal infection, one umbilical hernia, and one pedicle injury. Fat necrosis (13.2%) and epigastric bulging (21.7%) were common mastectomy- or reconstruction-associated complications, but most were mild and some resolved spontaneously. Over a median 38-month follow-up, there were three local, two regional, and three systemic recurrences. CONCLUSIONS SLOF reconstruction is a feasible and safe option for immediate breast reconstruction after NSM or extensive BCS with minimal donor-site morbidity and great cosmetic outcomes.
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Affiliation(s)
- Eun-Kyu Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea.
| | - Sumin Chae
- Department of Surgery, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
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Khater A, Abdelwahab K, El Din Sedky AH, Gaballa K. Use of Thoracodorsal Artery Perforator (Tdap) Flap to Cover a Laparoscopically Harvested Omental Flap After Modified Radical Mastectomy; a Case Report. Indian J Surg Oncol 2020; 11:52-55. [PMID: 33088130 DOI: 10.1007/s13193-020-01039-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 01/08/2020] [Indexed: 11/30/2022] Open
Abstract
Omental flap was introduced for breast reconstruction after mastectomy either alone or as an adjunct to prosthetic reconstruction. Laparoscopically harvested omental flap was used successfully for this issue. Most of reports had described its use after partial mastectomy, skin or nipple areola sparing mastectomies. In this case, we used the thoracodorsal artery perforator (Tdap) flap as a cover for the omental flap in a patient who underwent modified radical mastectomy. Modified radical mastectomy was done in the usual fashion. The descending branch of the thoracodorsal vessel was traced till its main perforator in an antegrade fashion. Then, the supplied skin island flap was created and rotated to cover the laparoscopically harvested omental flap that was delivered after its mobilization through a small epigastric wound from underneath the inner aspect of the lower mastectomy flap. The overall operative time was around 150 min. No blood transfusion was required. Pain score was around 6-7 in the early postoperative hours. No major complications were encountered, and the patient was discharged at the third postoperative day. The overall esthetic score was expressed as "good." To our knowledge, this is the first time to report usage of laparoscopically harvested omental flap after modified radical mastectomy with skin coverage by the thoracodorsal artery perforator (Tdap) flap. One criticism that may arise is the dual flap reconstruction; however, this method still as an alternative to the myocutaneous flaps with a reasonable operative time and minimal donor site and overall morbidities with good esthetic outcome. Modified radical mastectomy can be safely and efficiently reconstructed using a laparoscopically harvested omental flap with a cutaneous coverage using the thoracodorsal artery perforator (Tdap) flap.
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Affiliation(s)
- Ashraf Khater
- Department of Surgical Oncology, Mansoura Oncology center (OCMU), Faculty of Medicine, Mansoura University, Gomhoria Street, Mansoura, 35511 Egypt
| | - Khaled Abdelwahab
- Department of Surgical Oncology, Mansoura Oncology center (OCMU), Faculty of Medicine, Mansoura University, Gomhoria Street, Mansoura, 35511 Egypt
| | - Amr Hossam El Din Sedky
- Department of Surgical Oncology, Mansoura Oncology center (OCMU), Faculty of Medicine, Mansoura University, Gomhoria Street, Mansoura, 35511 Egypt
| | - Khaled Gaballa
- Department of Surgical Oncology, Mansoura Oncology center (OCMU), Faculty of Medicine, Mansoura University, Gomhoria Street, Mansoura, 35511 Egypt
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Hanan L, Lonjon G, Lellouch AG, Haddad K, Arago E, Hivelin M, Lantieri L. Omental flap for treatment of spondylodiscitis with lumbosacral dehiscence: A case report. ANN CHIR PLAST ESTH 2019; 65:263-268. [PMID: 31607500 DOI: 10.1016/j.anplas.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/09/2019] [Indexed: 11/15/2022]
Abstract
We report a case of pedicled omental flap use together with osteosynthesis treatment of a chronic L4-L5 spondylodiscitis due to a large sacral eschar. The 43-years-old patient was paraplegic and had depleted regional flaps solutions due to multiple previous surgeries. The procedure was carried out in supine position then in prone position whereby the dissected flap was recovered through the spine. The surgery was performed by a multidisciplinary team. First, we used an anterior approach for spine osteosynthesis with a metal implant and flap harvest. Then, in a prone position, we completed the vertebral reconstruction by an L3 athrodesis to the pelvis. The flap was recovered through the spine defect, on the side of the implant. It was a right sided pedicled. Complete wound healing was 120 days. The omental flap proved to be a reliable solution in the absence of recipient vessels for free flap transfer and depleted regional flap solutions. It also spared the latissimus dorsi muscle required for a wheelchair user as in our case. The omental flap is still performed in spine surgery especially in oncologic context to prevent wound dehiscence and for spondylodiscitis coverage. The anterior approach allows for both spine osteosynthesis and flap dissection.
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Affiliation(s)
- L Hanan
- Service de chirurgie plastique, université Paris Descartes, hôpital européen Georges Pompidou, Assistance publique-hôpitaux de Paris (AP-HP), 20 rue Leblanc, 75015 Paris, France.
| | - G Lonjon
- Service de chirurgie orthopédique, université Paris Descartes, hôpital européen Georges Pompidou, Assistance publique-hôpitaux de Paris (AP-HP), 75015 Paris, France
| | - A G Lellouch
- Service de chirurgie plastique, université Paris Descartes, hôpital européen Georges Pompidou, Assistance publique-hôpitaux de Paris (AP-HP), 20 rue Leblanc, 75015 Paris, France; Division of plastic and reconstructive surgery, Massachusetts general hospital, Harvard medical school, Boston, MA, USA; Vascularized composite allotransplantation laboratory, center for transplantation sciences, Massachusetts general hospital, Harvard medical school, Boston, MA, USA
| | - K Haddad
- Service de chirurgie plastique, université Paris Descartes, hôpital européen Georges Pompidou, Assistance publique-hôpitaux de Paris (AP-HP), 20 rue Leblanc, 75015 Paris, France
| | - E Arago
- Service de chirurgie viscérale, université Paris Descartes, hôpital européen Georges Pompidou, Assistance publique-hôpitaux de Paris (AP-HP), 75015 Paris, France
| | - M Hivelin
- Service de chirurgie plastique, université Paris Descartes, hôpital européen Georges Pompidou, Assistance publique-hôpitaux de Paris (AP-HP), 20 rue Leblanc, 75015 Paris, France
| | - L Lantieri
- Service de chirurgie plastique, université Paris Descartes, hôpital européen Georges Pompidou, Assistance publique-hôpitaux de Paris (AP-HP), 20 rue Leblanc, 75015 Paris, France
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Warner R, Beardmore-Gray A, Pakzad M, Hamid R, Ockrim J, Greenwell T. The cost effectiveness of vaginal versus abdominal repair of vesicovaginal fistulae. Int Urogynecol J 2019; 31:1363-1369. [PMID: 31321464 PMCID: PMC7306015 DOI: 10.1007/s00192-019-04015-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 05/31/2019] [Indexed: 11/29/2022]
Abstract
Introduction and hypothesis The objective was to assess the comparative provider costs of vaginal and open abdominal repair of vesicovaginal fistula (VVF) and to determine the most cost-effective means of managing VVF. Methods A prospectively acquired database of all women undergoing VVF repair by a single surgeon between 2007 and 2015 was retrospectively reviewed to determine operating time, perioperative complications, inpatient stay and 30-day readmissions. The success and cost of the VVF repair were identified. Statistical analysis was by unpaired t test, Chi-squared test and Mann–Whitney U test. Results Forty-seven consecutive women of mean age 51 years (range 21–88) undergoing a first attempt at VVF repair at our institution were included; 32(68%) had vaginal repair with Martius fat pad interposition and 15 (32%) had open abdominal repair with omental interposition. There were no perioperative complications or 30-day readmissions in either group. Mean operative time was longer for open abdominal (223.4 min) than vaginal repair (196.9 min). Median inpatient stay was longer for an open abdominal (8 days) than for a vaginal approach (4 days). Successful anatomical closure was achieved in 91% of vaginal and 86% of open abdominal repairs at first attempt, and in 100% after second repair, where required. Mean/median costs for an abdominal repair were significantly higher, at £4,608.69/£4,169.20 than for vaginal repair at £3,381.50/£3,009.24 (P<0.05). Conclusions Vesicovaginal fistulae were successfully repaired in 89% of cases at first attempt. The success rate did not differ between approaches. Vaginal repair is significantly more cost-effective than abdominal repair owing to the shorter operative time and length of stay.
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Affiliation(s)
- Ross Warner
- Department of Urology, University College London Hospital at Westmoreland Street, 16-18 Westmoreland Street, London, W1G 9PH, UK
| | - Alice Beardmore-Gray
- Department of Urology, University College London Hospital at Westmoreland Street, 16-18 Westmoreland Street, London, W1G 9PH, UK
| | - Mahreen Pakzad
- Department of Urology, University College London Hospital at Westmoreland Street, 16-18 Westmoreland Street, London, W1G 9PH, UK
| | - Rizwan Hamid
- Department of Urology, University College London Hospital at Westmoreland Street, 16-18 Westmoreland Street, London, W1G 9PH, UK
| | - Jeremy Ockrim
- Department of Urology, University College London Hospital at Westmoreland Street, 16-18 Westmoreland Street, London, W1G 9PH, UK
| | - Tamsin Greenwell
- Department of Urology, University College London Hospital at Westmoreland Street, 16-18 Westmoreland Street, London, W1G 9PH, UK.
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Welten VM, Fields AC, Lu P, Goldberg JE, Irani J, Bleday R, Melnitchouk N. Omental flaps in patients undergoing abdominoperineal resection for rectal cancer. Int J Colorectal Dis 2019; 34:1227-32. [PMID: 31123808 DOI: 10.1007/s00384-019-03319-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Following abdominoperineal resection (APR) for rectal cancer, perineal wound complications are common. Omental flap creation may allow for decreased morbidity. The aim of this study was to assess wound complications in rectal cancer patients undergoing APR with and without the addition of an omental flap. METHODS The National Surgical Quality Improvement Program Proctectomy targeted database from 2016 to 2017 was used to identify all patients undergoing APR for rectal cancer. The primary outcomes were wound complications such as superficial site infection, deep wound infection, organ space infection, and wound dehiscence. RESULTS There were 3063 patients identified. One hundred seventy-three (5.6%) patients underwent APR with an omental flap repair while 2890 (94.4%) patients underwent APR without an omental flap repair. Patients in both groups were similar with regard to age, gender, body mass index, American Society of Anesthesia class, and neoadjuvant cancer treatment (all p > 0.05). Patients who underwent an omental flap repair were significantly more likely to have a postoperative organ space infection (10.4% vs. 6.5%, p = 0.04). There was no significant difference in rates of superficial site infection, deep wound infection, wound dehiscence, or reoperation between the two patient groups. In multivariable analysis, omental flap creation was independently associated with organ space infection (OR 1.72, 95%CI 1.02-2.90, p = 0.04). CONCLUSIONS This is the largest study to evaluate omental flap use in rectal cancer patients undergoing APR. Omental flaps are independently associated with organ space infection.
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Özkan Ö, Özkan Ö, Çinpolat A, Arıcı C, Bektaş G, Can Ubur M. Robotic harvesting of the omental flap: a case report and mini-review of the use of robots in reconstructive surgery. J Robot Surg 2019; 13:539-543. [PMID: 30911884 DOI: 10.1007/s11701-019-00949-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 03/20/2019] [Indexed: 10/27/2022]
Abstract
This study describes the robotic harvesting of a free omental flap. The patient was a 58-year-old man who had undergone several previous operations due to osteomyelitis caused by trauma. There was a non-healing wound and purulent discharge in the distal pretibial region. The flap was harvested based on the right gastroepiploic artery using robotic facilities only. The flap was then transferred to the debrided defect in the pretibial region. Anastomoses were performed between the posterior tibial vessels and the pedicle of the flap. A split thickness skin graft was used to cover the omental flap. The operation lasted 2.5 h in total, including flap harvesting, microvascular anastomoses, inset and skin grafting. The postoperative period was uneventful and the patient was discharged on the 12th day postoperatively. The reliability of the technique is discussed in this report, together with a brief review of the use of robot surgery in reconstructive surgery in the literature.
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Affiliation(s)
- Ömer Özkan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Akdeniz University Hospital, Antalya, Turkey.
| | - Özlenen Özkan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Akdeniz University Hospital, Antalya, Turkey
| | - Anı Çinpolat
- Reconstructive and Aesthetic Surgery, Private Clinic, Plastic, Istanbul, Turkey
| | - Cumhur Arıcı
- Department of General Surgery, Akdeniz University Hospital, Antalya, Turkey
| | - Gamze Bektaş
- Reconstructive and Aesthetic Surgery, Private Clinic, Plastic, Istanbul, Turkey
| | - Mehmet Can Ubur
- Department of Plastic, Reconstructive and Aesthetic Surgery, Akdeniz University Hospital, Antalya, Turkey
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Endoh H, Yamamoto R, Nishizawa N, Satoh Y. Thoracoscopic surgery using omental flap for bronchopleural fistula. Surg Case Rep 2019; 5:5. [PMID: 30643997 DOI: 10.1186/s40792-019-0563-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 01/03/2019] [Indexed: 11/10/2022] Open
Abstract
Background A bronchopleural fistula (BPF) can lead to empyema and death after pulmonary resection. A minor leakage from a BPF has been reported to be successfully closed endobronchially, although thoracoplasty is usually needed. Case presentation A case of successful thoracoscopic BPF closure using an omental flap in a 74-year-old man with emphysema who developed a BPF after right lower lobectomy for lung cancer is reported. Reoperation was performed to close the BPF using an omental flap. After successful closure of the BPF, the empyema resolved with intravenous antibiotics. Conclusions Thoracoscopic single-stage omentoplasty without thoracotomy might be a useful treatment method when a BPF is diagnosed early.
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AlLababidi NH, AlOmran A, Hashem FK. The use of an omental flap for the reconstruction of a burn injury to the scalp: A case report. Int J Surg Case Rep 2018; 53:420-423. [PMID: 30567059 PMCID: PMC6260438 DOI: 10.1016/j.ijscr.2018.11.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/16/2018] [Accepted: 11/19/2018] [Indexed: 11/26/2022] Open
Abstract
Good out come with few adverse effect of a minimal invasive procedure. Renewal of a known method in head and neck reconstruction. The first reported reconstruction due to flame burn injury.
Introduction Omental free flaps are used in reconstructing a wide range of clinical indications in the head and neck. The first omental flap case to be reported was in 1972 by McLean and Buncke. Case presentation This case demonstrate the feasibility of minimal invasive procedure of harvest an omental flap laparoscopically to cover the entire scalp after a burn injury in a young male. It is first to be reported in Saudi Arabia at our institute, Riyadh, 2012. A 14-year-old male had an extensive flame burn at the age of 2 years in the head and neck area. He received multiple skin grafting procedures and an amputation of the right hand, due to his chronic condition of recurrent open wounds the patient was admitted for removal of the unstable ulcer sting and scarred skin of the scalp and for coverage with omental free flap and split thickness skin graft. Discussion The coverage of wounds in the head and neck is usually done by using a local skin flap. The disadvantage of using the traditional skin flaps is difficulty to shape it in irregular, and large wounds. Conclusion Owing its large size in covering wide defect, easy to shape in irregular edges over the bony surfaces, and high vascularity. This case demonstrate the feasibility of minimal invasive procedure of harvest an omental flap laparoscopically. We think that the use of omental flap is a useful flap and should be considered in the scalp and head and neck reconstruction.
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Affiliation(s)
- Noor H AlLababidi
- College of Medicine, Imam Abdulrahman Bin Fasial University, Dammam, Saudi Arabia.
| | - Asal AlOmran
- College of Medicine, AlFaisal University, Riyadh, Saudi Arabia.
| | - Fuad K Hashem
- King Faisal Specialist Hospital and Research Center (KFSHRC), Consultant Plastic Surgery, Riyadh, Saudi Arabia.
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Inatomi Y, Kadota H, Kaku K, Sonoda H, Tanoue Y, Shiose A. Omental and deep inferior epigastric artery perforator flap coverage after heart transplantation to manage wide left ventricular assist device exposure with pocket infection. J Artif Organs 2018; 21:466-470. [PMID: 30349955 DOI: 10.1007/s10047-018-1075-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/11/2018] [Indexed: 11/27/2022]
Abstract
Infection is a serious potential complication after left ventricular assist device (LVAD) implantation. In general, infection of the device pocket, with device exposure, should be managed by early device removal and heart transplantation. However, because of the small number of donors in Japan, accelerating access to heart transplantation is often difficult and the LVAD can be widely exposed during the waiting period. We report our experience of successful heart transplantation in a patient with a widely exposed LVAD with pocket infection. A 48-year-old man suffered from heart failure due to idiopathic dilated cardiomyopathy. An LVAD was implanted, but postoperative infection led to blood pump exposure. Heart transplantation was performed 4 months after LVAD exposure, at which time the epigastric skin defect measured 14 × 8 cm. The skin defect could not be closed after heart transplantation, so it was covered by an omental flap with split-thickness skin grafts. 7 days postoperatively, the peritoneal suture broke and the intestinal tract prolapsed outside the body. Reintroduction of the prolapsed intestinal tract and deep inferior epigastric artery perforator (DIEP) flap coverage of the omental flap were performed. The postoperative course was uneventful. There have been no reports of the management of wide skin defects in the presence of infection when heart transplantation is performed. Omental flap placement was useful for controlling long-lasting infection. An omental flap placed in a patient with a wide epigastric skin defect should be covered by durable skin flap, such as a DIEP flap, to avoid intestinal prolapse.
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Affiliation(s)
- Yusuke Inatomi
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, 3-1-1 Maidashi, Higashiku, Fukuoka, 812-8582, Japan.
| | - Hideki Kadota
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, 3-1-1 Maidashi, Higashiku, Fukuoka, 812-8582, Japan
| | - Keizo Kaku
- Department of Surgery and Oncology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Hiromichi Sonoda
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Yoshihisa Tanoue
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Akira Shiose
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
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Sambri A, Gasbarrini A, Cialdella S, De Iaco P, Boriani S. Pedicled omental flaps in the treatment of complex spinal wounds after en bloc resection of spine tumors. J Plast Reconstr Aesthet Surg 2017; 70:1267-71. [PMID: 28690123 DOI: 10.1016/j.bjps.2017.06.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/27/2017] [Accepted: 06/03/2017] [Indexed: 11/23/2022]
Abstract
STUDY DESIGN The present paper presents a retrospective study of 5 patients who underwent pedicled omental flap procedure following spine tumor removal. SUMMARY OF BACKGROUND DATA Postoperative wound dehiscence represents a major complication in spinal surgery, particularly after en bloc tumor resection, because of the extended sacrifice of soft tissues and adjuvant radiation therapy and chemotherapy. METHODS Five patients, with a mean age of 52 years (range, 24-71 years), who underwent omental flaps for the treatment of postoperative complication in spine tumor resections were retrospectively evaluated. RESULTS Four of 5 patients underwent omental transposition after a mean of 15 months (range, 4-27) from the previous surgery because of dehiscence of the wound (all of them had cerebrospinal fluid leak: 1 transpleural and in 3 cases, associated with deep infection), whereas one patient underwent the omental flap procedure at the time of elective spinal surgery because of several contemporary risk factors for wound healing. At the time of discharge after a mean of 36 days (range, 23-53), all patients had well-healed surgical wounds with an acceptable structural and aesthetic result. One of the patients had ileus, requiring surgical lysis of abdominal adhesions 3 months after omentum flap procedure. No other complications were observed. CONCLUSION Our data suggest that pedicled omental flap is a viable option for the treatment of complicated spinal wounds, helping in the resolution of the infection and CSF leak.
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Yamaguchi J, Miyamoto T, Hara N, Yamaguchi T, Umemoto T. Omental flap transposition for inferior vena cava filter penetration. Radiol Case Rep 2017; 12:81-83. [PMID: 28228885 PMCID: PMC5310262 DOI: 10.1016/j.radcr.2016.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 10/06/2016] [Accepted: 10/23/2016] [Indexed: 11/28/2022] Open
Abstract
A 40-year-old woman presented with uterine malignancy, deep vein thrombosis, and nonmassive pulmonary embolism in both lungs. Gunter-tulip filter was inserted, because she had severe genital bleeding, which is one of the contraindications to anticoagulation therapy. Total hysterectomy was conducted and anticoagulation therapy was started afterward. The thrombus worsened perioperatively, and the filter could not be retrieved. Since there was lymph node recurrence, the second time operation was performed. During operation, the struts were found to be penetrating the inferior vena cava. Omental flap was used to cover the struts, and no associated complications occurred after operation.
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Affiliation(s)
- Junji Yamaguchi
- Department of Cardiology, Musashino Red Cross Hospital, 1-26-1 Kyonan-cho, Musashino City, Tokyo 180-8610, Japan
| | - Takamichi Miyamoto
- Department of Cardiology, Musashino Red Cross Hospital, 1-26-1 Kyonan-cho, Musashino City, Tokyo 180-8610, Japan
| | - Nobuhiro Hara
- Department of Cardiology, Musashino Red Cross Hospital, 1-26-1 Kyonan-cho, Musashino City, Tokyo 180-8610, Japan
| | - Tetsuo Yamaguchi
- Department of Cardiology, Musashino Red Cross Hospital, 1-26-1 Kyonan-cho, Musashino City, Tokyo 180-8610, Japan
| | - Tomoyuki Umemoto
- Department of Cardiology, Musashino Red Cross Hospital, 1-26-1 Kyonan-cho, Musashino City, Tokyo 180-8610, Japan
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Takagi C, Baba H, Yamafuji K, Asami A, Takeshima K, Okamoto N, Takahashi H, Kubochi K. Simultaneously Diagnosed and Successfully Treated Rectovaginal and Vesicovaginal Fistulae after Low Anterior Resection with Concomitant Resection of Female Genitalia. Case Rep Gastroenterol 2017; 11:17-22. [PMID: 28203133 PMCID: PMC5301109 DOI: 10.1159/000455187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 12/15/2016] [Indexed: 11/27/2022] Open
Abstract
Rectovaginal fistula (RVF) and vesicovaginal fistula (VVF) are infrequent but distressing complications after pelvic surgery. However, their adequate treatment is not well described. Here, we simultaneously encountered and successfully treated RVF and VVF after radical surgery for rectal cancer. A 70-year-old woman underwent low anterior resection (LAR) combined with resection of the uterus, the bilateral adnexa, and the upper side of the vagina, as well as diverted ileostomy for rectal cancer. A month after the surgery, she developed urinary incontinence and underwent medical treatment, but her symptoms did not improve. Evaluation with contrast enema before stoma closure revealed the presence of RVF and VVF. We repaired the VVF and RVF via transabdominal and transperineal approaches. After 6 months, ileostomy was closed and the patient had no recurrence of cancer and fistula. In LAR with hysterectomy and resection of the vaginal wall, there is a risk of RVF and VVF. The excision and closure of the fistula tract and omental flap can be effective to treat both fistulae.
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Affiliation(s)
- Chisato Takagi
- Department of Surgery, Saitama City Hospital, Saitama City, Japan
| | - Hideo Baba
- Department of Surgery, Saitama City Hospital, Saitama City, Japan
| | - Kazuo Yamafuji
- Department of Surgery, Saitama City Hospital, Saitama City, Japan
| | - Atsunori Asami
- Department of Surgery, Saitama City Hospital, Saitama City, Japan
| | - Kaoru Takeshima
- Department of Surgery, Saitama City Hospital, Saitama City, Japan
| | - Nobuhiko Okamoto
- Department of Surgery, Saitama City Hospital, Saitama City, Japan
| | - Hidena Takahashi
- Department of Surgery, Saitama City Hospital, Saitama City, Japan
| | - Kiyoshi Kubochi
- Department of Surgery, Saitama City Hospital, Saitama City, Japan
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Zaha H, Abe N, Sagawa N, Unesoko M. Oncoplastic surgery with omental flap reconstruction: a study of 200 cases. Breast Cancer Res Treat 2017; 162:267-274. [PMID: 28120273 DOI: 10.1007/s10549-017-4124-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 01/18/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are several small case series on use of a laparoscopically harvested omental flap (LHOF) for breast reconstruction. However, the long-term oncological safety and clinical benefits of the LHOF remain uncertain, especially in use of the flap in oncoplastic breast surgery. STUDY DESIGN A retrospective chart review was performed for 200 patients who underwent oncoplastic breast surgery using a LHOF at our institution from April 2002 to March 2016. Laparoscopy-associated complications, local recurrence, and cosmetic outcomes were evaluated. RESULTS Most of the patients underwent partial breast reconstruction immediately after breast-conserving surgery (BCS). The success rate of laparoscopic harvesting of the omental flap was 99.5%. The rate of complications was 12.0% and laparoscopy-associated complications occurred in four cases (2.0%). The rate of a positive margin was 6.5%. Two cases (1.0%) had local recurrence during a median follow-up period of 90 months. In 24 patients (12.0%), the volume of the flap was insufficient. When applied to total reconstruction, volume insufficiency occurred in 32.6% of patients. Cosmetic outcomes were mostly satisfactory. Approximately 80% of patients were rated as good or excellent by evaluation using a 4-point scale and Breast Cancer Conservative Treatment cosmetic results (BCCT.core) software. Donor-site scars were negligible, as in laparoscopic cholecystectomy. CONCLUSIONS The LHOF has minimal donor-site morbidity and deformity, and oncological safety is promising. There is a limit to the adaptable volume, but the LHOF is an attractive option in partial breast reconstruction after BCS.
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Affiliation(s)
- Hisamitsu Zaha
- Department of Breast Surgery, Nakagami Hospital, 610 Noborikawa, Okinawa-city, Okinawa, Japan.
| | - Norie Abe
- Department of Breast Surgery, Nakagami Hospital, 610 Noborikawa, Okinawa-city, Okinawa, Japan
| | - Noriko Sagawa
- Department of Breast Surgery, Nakagami Hospital, 610 Noborikawa, Okinawa-city, Okinawa, Japan
| | - Mikiko Unesoko
- Department of Breast Surgery, Nakagami Hospital, 610 Noborikawa, Okinawa-city, Okinawa, Japan
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Uchibori T, Takanari K, Hashizume R, Amoroso NJ, Kamei Y, Wagner WR. Use of a pedicled omental flap to reduce inflammation and vascularize an abdominal wall patch. J Surg Res 2016; 212:77-85. [PMID: 28550925 DOI: 10.1016/j.jss.2016.11.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/23/2016] [Accepted: 11/29/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although a variety of synthetic materials have been used to reconstruct tissue defects, these materials are associated with complications such as seromas, fistulas, chronic patient discomfort, and surgical site infection. While alternative, degradable materials that facilitate tissue growth have been examined. These materials can still trigger a foreign body inflammatory response that can lead to complications and discomfort. MATERIALS AND METHODS In this report, our objective was to determine the effect of placing a pedicled omental flap under a biodegradable, microfibrous polyurethane scaffold serving as a full-wall thickness replacement of the rat abdominal wall. It was hypothesized that the presence of the omental tissue would stimulate greater vascularization of the scaffold and act to reduce markers of elevated inflammation in the patch vicinity. For control purposes, a polydimethylsiloxane sheet was placed as a barrier between the omental tissue and the overlying microfibrous scaffold. Both groups were sacrificed 8 wk after the implantation, and immunohistological and reverse transcription polymerase chain reaction (RT-PCR) assessments were performed. RESULTS The data showed omental tissue placement to be associated with increased vascularization, a greater local M2/M1 macrophage phenotype response, and mRNA levels reduced for inflammatory markers but increased for angiogenic and antiinflammatory factors. CONCLUSIONS From a clinical perspective, the familiarity with utilizing omental flaps for an improved healing response and infection resistance should naturally be considered as new tissue engineering approaches that are translated to tissue beds where omental flap application is practical. This report provides data in support of this concept in a small animal model.
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Affiliation(s)
- Takafumi Uchibori
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keisuke Takanari
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryotaro Hashizume
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nicholas J Amoroso
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yuzuru Kamei
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - William R Wagner
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania.
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Perrone AM, Livi A, Fini M, Bondioli E, Concetti S, Morganti AG, Contedini F, De Iaco P. A surgical multi-layer technique for pelvic reconstruction after total exenteration using a combination of pedicled omental flap, human acellular dermal matrix and autologous adipose derived cells. Gynecol Oncol Rep 2016; 18:36-39. [PMID: 27844048 PMCID: PMC5097956 DOI: 10.1016/j.gore.2016.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 10/23/2016] [Accepted: 10/25/2016] [Indexed: 11/01/2022] Open
Abstract
•A multi-layer technique for reconstruction after pelvic exenteration is proposed.•Human acellular dermal matrix used in reconstruction after total pelvic exenteration.•A reconstructive technique based on human dermis, omental flap and fat is proposed.
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Affiliation(s)
- Anna Myriam Perrone
- Oncologic Gynecology Unit, Sant'Orsola-Malpighi Hospital, via Massarenti 13, 40138 Bologna, Italy
| | - Alessandra Livi
- Oncologic Gynecology Unit, Sant'Orsola-Malpighi Hospital, via Massarenti 13, 40138 Bologna, Italy
| | - Milena Fini
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, 40136 Bologna, Italy
| | - Elena Bondioli
- Burns Intensive Care Unit and 'Regione Emilia Romagna' Skin Bank, Bufalini Hospital, viale Ghirotti 286, 47023 Cesena, Italy
| | - Sergio Concetti
- Complex Pelvic Surgery Unit, Sant'Orsola-Malpighi Hospital, via Palagi 9, 40138 Bologna, Italy
| | | | - Federico Contedini
- Department of Plastic and Reconstructive Surgery, S. Orsola-Malpighi Hospital, via Massarenti 13, 40138 Bologna, Italy
| | - Pierandrea De Iaco
- Oncologic Gynecology Unit, Sant'Orsola-Malpighi Hospital, via Massarenti 13, 40138 Bologna, Italy
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Hishida M, Toriyama K, Yagi S, Ebisawa K, Morishita T, Takanari K, Kamei Y. Does a muscle flap accelerate wound healing of gastric wall defects compared with an omental flap? Int J Surg 2015; 18:41-7. [PMID: 25865082 DOI: 10.1016/j.ijsu.2015.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 03/14/2015] [Accepted: 03/25/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Most often used for reconstruction at superficial sites, a muscle flap recently was reported to promote clinical wound healing in a duodenal defect. We therefore examined whether a muscle flap could promote wound healing comparably to an omental flap in rats with gastric wall defects. METHODS After perforation of the centre of the anterior gastric wall, rats were divided into 2 groups. In the muscle group, a muscle flap was fixed to the defect; in the omentum group, an omental flap was placed over the defect. We histopathologically compared tissue responses during gastric wall healing. RESULTS While stratified villi had completely covered the defect by day 7 in both groups, scar maturation differed. Scar tissue persisted in the muscle group, but was gradually replaced by adipose tissue in the omentum group. DISCUSSION Both muscle and omental flaps accelerated gastric wall wound healing. CONCLUSION A muscle flap is an excellent alternative for repair of gastric defects when no omental flap is available.
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Affiliation(s)
- Masashi Hishida
- Department of Plastic and Reconstructive Surgery, Kasugai Municipal Hospital, 1-1-1 Takagi-cho, Kasugai 486-8510, Japan; Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, 65 Turumai-cho, Showa-ku, Nagoya 466-8550, Japan.
| | - Kazuhiro Toriyama
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, 65 Turumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Shunjiro Yagi
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, 65 Turumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Katsumi Ebisawa
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, 65 Turumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Tsuyoshi Morishita
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, 65 Turumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Keisuke Takanari
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, 65 Turumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Yuzuru Kamei
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, 65 Turumai-cho, Showa-ku, Nagoya 466-8550, Japan
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Ratan SK, Gangurde A, Sinha SK, Singh S, Sharma BC, Aggarwal SK. Pedicled omental onlay flap for post-traumatic intrahepatic major ductal injury. APSP J Case Rep 2013; 4:38. [PMID: 24381834 PMCID: PMC3863827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 07/03/2013] [Indexed: 11/30/2022] Open
Abstract
We report a 5-year-old girl who presented with post traumatic biliary leakage that failed to respond to conservative management for two weeks. Surgical exploration in the third week revealed a partially healed 5 cm long hepatic laceration in the right lobe of the liver. Bile was found leaking through a rent in the major right intra-hepatic duct at the apex of liver laceration. A pedicled onlay omental flap was used to buttress this rent as direct closure was not possible due to friable tissue. The child recovered uneventfully.
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Affiliation(s)
- Simmi K Ratan
- Department of Pediatric Surgery, Maulana Azad Medical College and Lok Nayak Hospital
| | - Anita Gangurde
- Department of Pediatric Surgery, Maulana Azad Medical College and Lok Nayak Hospital
| | - Shandip K Sinha
- Department of Pediatric Surgery, Maulana Azad Medical College and Lok Nayak Hospital
| | - Sudhir Singh
- Department of Pediatric Surgery, Maulana Azad Medical College and Lok Nayak Hospital
| | | | - Satish K Aggarwal
- Department of Pediatric Surgery, Maulana Azad Medical College and Lok Nayak Hospital
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Romanini MV, Vidal C, Godoy J, Morovic CG. Laparoscopically harvested omental flap for breast reconstruction in Poland syndrome. J Plast Reconstr Aesthet Surg 2013; 66:e303-9. [PMID: 23972535 DOI: 10.1016/j.bjps.2013.08.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 07/27/2013] [Accepted: 08/04/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND/PURPOSE Poland syndrome (PS) is a congenital anomaly of the thoracic wall characterised by a variable degree of unilateral agenesis of pectoralis major and minor muscles associated with ipsilateral breast, rib and upper-arm anomalies. In female patients, breast reconstruction is particularly challenging because of cranial pectoralis muscle defects and partial or complete breast agenesis. Different techniques have been used to treat the thoracic anomaly, including the positioning of an implant, fat transfer or latissimus dorsi transposition, but in some cases these techniques are not feasible resulting in a poor reconstruction. METHODS We present our experience in correction of the chest anomaly of PS in a teenage population by using a pedicled laparoscopically harvested omental flap (LOF) to cover a pectoral or breast prosthesis. Procedures were performed by a surgical team which included experienced plastic surgeons and general paediatric surgeons. Preoperative endocrinological and psychological evaluation helped to determine the best timing for the correction. RESULTS The technique was adopted in 20 patients aged 14-18 years, affected by the syndrome. In all cases, it was possible to harvest an adequate amount of pedicled omentum laparoscopically. Neither significant complications nor conversions to open surgery occurred. The aesthetic outcome of the LOF technique was, in all cases, a soft, natural-looking breast and a satisfactorily corrected infraclavicular defect. CONCLUSIONS The LOF technique is a valid alternative to reconstruction in selected PS cases. It provides a satisfactory reconstruction of the breast and pectoral region and corrects the infraclavicular defect by filling in the area. It avoids the invasiveness and morbidity of a latissimus dorsi transposition.
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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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