Search Results (5)

Background: The greater omentum is a highly vascularized and biologically active structure with drainage, immunomodulatory, proangiogenic, and proregenerative properties. Although it is widely used in abdominal surgery, its extra-abdominal application in dogs and cats remains less standardized. Methods: This review summarizes the available veterinary literature on extra-abdominal omentalization in small animals, including case reports, case series, experimental studies, and selected comparative data, supplemented by relevant evidence from human reconstructive surgery. Results: Two main surgical strategies are described: transposition of a pedicled omental flap with preservation of vascular continuity and free omental grafting, with or without microvascular anastomosis. Reported applications include thoracic surgery, chronic and infected wounds, orthopedic conditions associated with impaired healing, head and neck reconstruction, and experimental neurosurgical procedures. The omentum may support healing by improving vascularization, filling dead space, promoting drainage, and contributing to infection control. Conclusions: Current evidence suggests that extra-abdominal omentalization may be valuable as an adjunctive technique in selected complex cases, particularly when infection, poor vascularization, dead space, or delayed healing are present. However, further clinical studies are needed to define indications, outcomes, and safety more precisely. Full article

Laparoscopically harvested pedicled omental flap (LHPOF) reconstruction is a minimally invasive autologous option for immediate breast reconstruction, but prior reviews have largely examined omental flaps broadly, combining open and laparoscopic harvests, free and pedicled transfers, and mixed reconstructive indications. This systematic review evaluated operative characteristics, peri-operative complications, and esthetic outcomes following LHPOF after oncologic breast surgery. MEDLINE, Cochrane and Embase were searched without language or date restrictions, with backward citation searching of included studies. Eligible studies included female patients undergoing immediate unilateral breast reconstruction with LHPOF after mastectomy or BCS. Twenty-two studies published between 2001 and 2025 were included, representing 1869 patients. Operative techniques were broadly consistent, most commonly involving transverse-colon-first omental harvest, preservation of the right gastroepiploic vessels, and tunnelling from the inframammary fold toward the xiphoid. Reported complications included omental fat necrosis, partial flap loss, hematoma, infection, epigastric bulging, and incisional or tunnel-site hernia. Esthetic outcomes were generally favourable but assessed using heterogeneous methods. Current evidence suggests this technique is feasible in selected patients and may offer favourable esthetic outcomes with limited donor-site morbidity. However, prospective comparative studies with standardized reporting are needed to define optimal patient selection, long-term safety, and esthetic durability. Full article

The use of an omental pedicle flap as an adjuvant treatment has gained popularity in veterinary medicine due to its versatility. This technique has been successfully applied in both intra-abdominal and extra-abdominal surgeries in human as well as veterinary medicine. In most intra-abdominal procedures, the greater omentum can be easily accessed through a midline laparotomy and directed to the area of interest. However, dogs and cats are typically positioned in lateral recumbency for extra-abdominal surgeries involving the thorax or limbs. In such cases, a lateral approach to the greater omentum could minimize the risk of infection or trauma associated with patient repositioning. This cadaver study evaluated the feasibility of accessing the greater omentum through a lateral approach laparotomy in both left and right lateral recumbency. A total of 22 cadavers (13 cats and 9 dogs) were included. Dorsal extension of the greater omentum was successfully performed in all specimens without major structural damage. Further elongation using an inverted L-shaped pedicle flap was achieved without rupture in 17 of 22 cadavers (77.3%). The results demonstrate that lateral approach laparotomy provides reliable access to the greater omentum and allows successful mobilization of the omentum for potential extra-abdominal applications, with no significant differences observed between left and right lateral approaches. This technique may represent a useful alternative in clinical situations where repositioning the patient is not feasible or carries increased surgical risk. Full article

Background and Objectives: Perineal wound complications and pelvic fluid collections or abscesses following proctectomy for Crohn’s disease are a common cause of morbidity and might be mitigated by filling the pelvis and occluding the pelvic inlet with a flap. Alternative flap options can be considered when inadequate omentum is available and when avoiding myofasciocutaneous flaps. Materials and Methods: A retrospective review of our Crohn’s proctectomy database was conducted to identify patients who underwent a non-omental or non-myofasciocutaneous local pedicle flap to their pelvis or pelvic exclusion using biological material during surgery. The techniques and outcomes of these alternative techniques are described in detail. Results: 228 patients underwent proctectomy for Crohn’s disease during the 10-year study period. However, only six patients had their pelvis filled or pelvic inlet occluded using a non-omental, non-myofasciocutaneous local pedicled flap or biological material. The techniques identified included two sigmoid mesocolic flaps, one peritoneal, preperitoneal fat and falciform ligament flap, one perivesical fat flap, one Gerota’s fat pad flap, and one bovine pericardial patch assisted pelvic exclusion. These flaps’ clinicopathological and operative characteristics, surgical outcomes, and technical aspects are described. Conclusions: When greater omentum is unavailable or inadequate and myofasciocutaneous flaps need to be avoided, local pedicled flaps using a range of intra-abdominal tissues or biological material can be used to fill the pelvis or occlude the pelvic inlet after proctectomy for Crohn’s disease. These techniques may help to prevent short and long-term complications associated with having a pelvic dead space. Full article

Microsurgical scalp reconstruction is indicated in patients with large scalp defects. The aim of this study was to compare the outcomes of scalp reconstruction in oncologic patients reconstructed with latissimus dorsi (LD), anterolateral thigh (ALT), and omental (OM) free flaps. Thirty oncologic patients underwent scalp reconstruction with LD (10), ALT (11), and OM (9) flaps. The length of the vascular pedicle, the operation time, the possibility of a two-team approach, the length of hospital stays, the complications, and the aesthetic results were evaluated. The OM flap was the flap with the shortest vascular pedicle length with a mean of 6.26 ± 0.16 cm, compared to the LD flap, which was 12.34 ± 0.55 cm and the ALT flap with 13.20 ± 0.26 cm (p < 0.05). The average time of surgery was 6.6 ± 0.14 h in patients reconstructed with OM, compared to the LD flap, which was 8.91 ± 0.32 h and the ALT flap with 7.53 ± 0.22 h (p < 0.05). A two-team approach was performed in all patients for OM flaps and ALT flaps, but only in two patients reconstructed with the LD flap (p < 0.001). In patients reconstructed with the OM flap, a very satisfactory or satisfactory result was reported in seven patients (77.8%). Eight patients reported a very unsatisfactory or unsatisfactory result with LD flap (80%) and 10 patients with ALT flap (90.9%) (p = 0.002). The mean hospital stay after surgery was not statistically significant (p > 0.05). As for complications, two patients reconstructed with OM flap, five LT flaps, and two ALT flaps developed complications, not statistically significant (p = 0.235). Omental flap, latissimus dorsi flap, and anterolateral thigh flap fulfill most of the characteristics for complex scalp reconstruction. The decision on which flap to use should be based on clinical aspects of the patients taking into account that the three flaps show similar rates of complications and length of hospital stay. Regarding the aesthetic outcome, OM flap or LD flap should be considered for reconstruction of extensive scalp defects. Full article