Page 26 - PlasticosVol4

V O L 4 2019 I S S U E
Figure 2
Figure 2 shows the defect in the peritoneum
which was extended and omentum was
exposed, separated, following which the entire
omentum was raised based on the right
gastroepiploic vessels, perfusion secured by
the arc of Barkow.
Figure 3 The omental flap was brought out of
the peritoneal defect and an intraperitoneal
underlay technique utilizing a bilayer prosthetic
mesh was utilized, over which the peritoneum
was closed.
Figure 4 Omentum was spread over whole
of the defect which was covered with split
thickness graft.
Figure 5 Follow up picture.
Technique
The omentum was identified and the
mobilization was begun by dissecting the
omentum along the avascular embryologic
fusion plane along the transverse colon. The
lateral splenic attachments and short gastric
vessels were divided to pedicle the omental flap
on right gastroepiploic vessels. Harvesting the
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flap by dissecting the greater omentum from
Figure 3
flap by dissecting the greater omentum from
the great curvature of the stomach, pedicled
by the right gastroepiploic artery, the perfusion
is secured by the arc of Barkow.
Figure 4
Tip Case 2
Omental flap can be lengthened by dividing A 38 yr old man, biopsy proven case of
the gastroepiploic artery between the right squamous cell carcinoma of natal cleft/spina
and left omental artery. bifida with involvement of sacrum, anal canal
and rectum.
Figure 5
Figure 6
Discussion
Kiricuta popularized the omental flap’s use as Figure 6 points out the challenges- the extent
a pedicle flap and was the first to describe it of the disease shows the size of the defect
in reconstruction of the breast after breast about to be made, encompassing major part of
cancer in 1963. Subsequently, omental flaps gluteal region to perineum, large dead space
[1]
have found many indications in thoracic and in pelvic cavity, with exposed sacrococcygeal
reconstructive surgery. region i/v/o resection.
The popularity of the omentum flap has Initial considerations:
been variable over the past decades but new 1. Gracilis flap
harvesting techniques have been developed 2. Rotational or advancement thigh flaps
that aim to reduce donor site morbidity. [2] 3. Omental flap
The advantages of omental flap being thin 4. Tensor fascia lata flap
and pliable, large surface area, long pedicle, 5. Gluteus maximus muscle flap
angiogenic and immunogenic properties,
relatively fast and easy harvest, robust blood Obligation to obliterate the dead space in
supply allows containing infections, absorbing the pelvic cavity and to provide a stable
exudates, and furnishing a good base for skin and reliable perineal reconstruction, with
grafts. [3] tension-free closure with introduction of a
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