Laparoscopically Harvested Omental Flap for Chest Wall and Intrathoracic Reconstruction

Abstract

Minimally invasive surgery has gained popularity in the last decade and its applications to plastic surgery are expanding. Pedicled omental flaps are used for the reconstruction of chest wall defects following debridement of sternal infections and mediastinitis. The main advantages of using an omental flap are its large size and bulk to fill large 3-dimensional dead spaces, long pedicle, and rich vascular and lymphatic networks. Recently, laparoscopic techniques have been described for harvesting omental flaps. Over the last 5 years in our institution, 9 laparoscopic omental flap harvests were performed. Seven were used in the reconstruction of complicated chest wall defects, sternal infections, mediastinal abscesses, and mediastinitis following cardiac surgery. Two were used to repair intrathoracic viscera. Prior abdominal surgery was not a contraindication to the laparoscopic harvest. In 1 patient, the omental transfer was converted to a free flap due to the detachment of the pedicle, and in 1 patient the omental harvest was converted to open technique due to technical difficulty due to severe abdominal adhesions. None of the patients had major intraabdominal complications postoperatively. One patient had a small transdiaphragmatic hernia treated by laparoscopic techniques. The use of laparoscopy techniques facilitated the harvesting of the omentum, making it ideal in the treatment of complicated patients with multiple comorbidities. With these techniques, pedicled omental flaps will be a reasonable treatment option for chest wall reconstruction.

Reconstruction of the chestwall and thorax

“…A disadvantage of the omental flap is that its harvest necessitates a laparotomy, with potential intraabdominal morbidity. Intraabdominal morbidity may perhaps be minimized by a laparoscopic flap harvest approach [38]. Furthermore, the incidence of abdominal hernias is as high as 21% when the omentum is transposed to a chest wall defect via a subcutaneous tunnel, making a transdiaphragmatic route preferable [39].…”

A general algorithm for chest wall reconstruction based on a retrospective review

“…F u r t h e rm o re , laparoscopically harvested omental flaps have been shown to be successful in the long-term control of sternal and intrathoracic infections when muscle flaps have failed [12]. The use of minimally invasive techniques has also reduced the risk of intraabdominal complications associated with laparotomy [12]. In our center, we select the use of omental flap in patients with radionecrosis or chronic recalcitrant infections due to its intrinsic immunologic properties and malleability.…”

“…A recent meta-analysis had suggested that the use of omental flaps in deep sternal infections may be associated with lower mortality and fewer complications c o m p a r e d t o m u s c l e f l a ps [11 ] . F u r t h e rm o re , laparoscopically harvested omental flaps have been shown to be successful in the long-term control of sternal and intrathoracic infections when muscle flaps have failed [12]. The use of minimally invasive techniques has also reduced the risk of intraabdominal complications associated with laparotomy [12].…”

Enhancing Clinical Islet Transplantation through Tissue Engineeering Strategies

“…53 Furthermore, an ECM protein coating led to a reduction in the time required to achieve diabetes reversal in mice, postulated to be due to the promotion of endothelial cell infiltration. 54 Berman and associates 43 have also reported using scaffolds for implantation of islets in their evaluation of the omentum as an alternative transplantation site using a nonhuman primate model. 44 Although these scaffolds do not provide immunoisolation from the host, they provide a vehicle for islet transplantation that promotes engraftment, revascularization, and integration of the implant with the host.…”

“…[35][36][37][38][39] It has been postulated that this site may also promote islet engraftment, given its demonstrated ability to facilitate healing and positive remodeling in clinical settings. [40][41][42][43] This site has clinical relevance and is feasible in larger animal models, further justifying the need for additional investigations as to its potential. 25,44 …”