The omental free flap and flow-through flap: pre-operative evaluation of right gastro-omental artery on multidetector computed tomography

BACKGROUND

The gastro-omental artery (GOA) and the greater omentum are nowadays commonly used in many reconstructive surgeries, including cardiac, vascular, and plastic surgery. There are cases in which the GOA is found to be unsuitable only after partial harvesting following an upper laparotomy, and an improved method of pre-operative evaluation is required to eliminate the need for intraoperative small laparotomy.

METHODS

Multidetector computed tomography was performed for 30 consecutive patients admitted for lower limb ischemia in a routine pre-operative evaluation of lower limb peripheral arterial disease (PAD). The origin of the GOA was checked on coronal and sagittal slices, its pathway was identified on the three-dimensional rendering. We assessed length and mean diameter of the distal and proximal right GOA, and the mean distances between the origins of GOA and the omental branches. Finally, we report one case of omental flow-through flap.

RESULTS

30 patients were included in our study. Routine pre-operative MDCT during lower limb PAD workup enabled identification of GOA in all cases. The mean internal diameter of the GOA at its origin was 3.3 mm (± 3.3). The mean internal diameter of the distal GOA was 1.26 mm (± 0.3). At least one omental descending branch was detected in every case and in 63% (19 patients) at least two branches were visualized.

CONCLUSION

Routine pre-operative angio-MDCT imaging is an effective tool to assess precisely the different anatomical properties of the GOA. This exam could be useful for both diagnosis of lower limb PAD and evaluation of the GOA suitability for flow-through flap lower limb revascularisation.

Surgical anatomy of the right gastro-omental artery: a study on 100 cadaver dissections

PURPOSE

The gastro-omental artery (GOA) with the greater omentum (GO) is known for its high quality as a vascular graft, its resistance to infections as an omental flap and for its multiple applications in surgery. A better knowledge of anatomical variations of GO and its vascularization can improve the application in surgery and decrease complications. The purpose of this study was to measure diameters and lengths of the right GOA (RGOA) and study the interindividual variability of these anatomical structures.

METHODS

In 100 cadaveric dissections, we carried out dissection of the RGOA and of the GO. In 70 unfixed cadavers, the transillumination technique was used to identify all RGOA branches. In the remaining 30 cadavers, prepared with Winckler's solution, barium sulfate with colored latex was injected. Digital X-ray was used to measure RGOA lengths, internal diameters and the distribution of the omental branches. The gastro-omental vein was also dissected.

RESULTS

The mean proximal and distal diameters of RGOA were 2.68 (± 0.39) mm and 0.94 (± 0.24) mm, respectively. The mean length was 244.3 (± 34.4) mm. The thickness of the omentum ranged from 5 to 15.5 mm. The arteria omentalis magna, defined in this study for the fist time as the longest and widest omental branch, was present in 73.3% cases. The trans-omental arch was present in 6% cases.

CONCLUSIONS

This morphometric study allowed us to define the vascularization and the anatomical variations of RGOA and GO. This may lead to improvement of applications in surgery and decrease complications.