Free Versus Pedicled Omental Grafts for Limb Salvage in Buerger's Disease

Abstract

Background: Buerger's disease is a disabling and progressive disease that affects young smokers with a variable and unpredictable course. Free or pedicled omental transfer are the possible modes of management for these patients, and these modes are compared in the present study. Methods: Of the 43 patients who had Buerger's disease who were treated at the Department of Surgery, Jawahar La1 Nehru (JLN) Hospital, Ajmer, between January 1990 and December 1995, 15 patients underwent application of free omental grafts (group A); 28 patients underwent pedicled omental transplantation (group B). The clinical results obtained with the use of either technique were compared. Results: There were no statistically significant differences in the relief of intermittent claudication (80% vs 82%). rest pain (82% vs 91%), coldness (83% vs 87%), discolouration (80% vs 82%), ulceration (75% vs 78%) and post-amputation ulcer healing (75% v s 86%) in the two groups (P > 0.05); but the time taken for the relief of intermittent claudication, rest pain and coldness was significantly less in group B. Major amputations were not required in both the groups. Conclusions: These findings suggest that the ultimate clinical benefits obtained with the use of either free or pedicled omental grafts in patients with Buerger's disease are similar, supporting a possible local action of the omentum.

Effect of intrahepatic omental implantation on angiogenesis in rat liver with hepatic artery ligation

“…It is important, however, that this parameter also contains information on function. It is difficult to measure hepatic artery blood flow due to the small caliber of the vessel, low flow rates, and the two hepatic circuits of portal vein and hepatic artery [1,3]. Since hepatic artery flow is regarded as 1/10 of the portal blood flow in rat liver, it is also difficult to recognize slight changes in liver tissue blood flow under clamp of the portal vein by laser Doppler flowmeter, although this method is prevalent for measuring liver blood flow.…”

“…Goldsmith used the omentum to help drain lymphatic fluid from legs with lymphedema [2]. Since then, studies have proven that the omentum has angiogenic potential and the ability to promote neovascularization in chronically ischemic organs [3,4]. Recently, laparoscopic omental patch repair has been performed for perforated duodenal ulcer, precipitating a vascular source for the injured region from the omentum [5].…”

Buerger’s Disease: Clinical Aspects and Evidence-Based Treatments

“…The mechanism whose omentum promotes angiogenesis is unknown. Indian and Russian groups of researchers published good results with the technique, with highlights to the works of Singh [38] (reaching 88% of ulcer healing) and Talwar [39] (100% of limb salvage in 62 patients). However, because of the design of the studies (prospective case series), the evidence is very low.…”

The Omental Free Flap—A Review of Usage and Physiology

“…81 Many studies have demonstrated efficacy of the omental flap to revascularize upper and lower limbs affected by Buerger's disease. [82][83][84] Originally, the flap was transferred on a pedicle, leading researchers to theorize that the salvaging of the limb was due to the introduced vessel. However, the comparability of the free flap in limb salvage suggests that its effect is due to neovascularization rather than the pedicled vessel itself.…”