Revascularization of the Lower Extremity with Omentum

Hr, Herrera; Geary, Joseph E.; Whitehead, Phyllis; Evangelisti, Stephen M.

doi:10.1016/s0094-1298(20)30847-6

Cited by 19 publications

(3 citation statements)

References 9 publications

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“…A free omenmm covered immediately by skin graft was chosen when excessive length was required. 6 Plantar wounds did not preclude reconstruction in our series. No patient was provided with a sensate soft-tissue reconstruction.…”

Section: Discussionmentioning

confidence: 55%

Extension of limb salvage by combined vascular reconstruction and adjunctive free-tissue transfer

Serletti¹,

Hurwitz²,

Jones³

et al. 1993

Journal of Vascular Surgery

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Vascular reconstruction alone can be insufficient for extremity salvage in some patients with severe soft-tissue wounds. We present our experience in 20 patients with vascular reconstruction for ischemic disease and free-tissue transfer for limb-threatening soft-tissue wounds. Methods: Nineteen patients underwent autogenous venous bypasses and one patient underwent an aortobifemoral bypass. Ten soft-tissue reconstructions were performed at the time of the vascular reconstruction and 10 were delayed. Free-tissue transferred included muscle, fasciocutaneous flaps, and omentum. Inflow to the flap was from the bypass graft (n = 12) or the distal tibial artery. Results: One free flap and graft failed immediately in the same patient. One successful flap and graft required a below-knee amputation for ongoing infection in the surrounding soft tissues. Eighteen of 20 patients have had free-flap and graft patency during the mean follow-up period of 17 months (range 6 to 33 months). These 18 patients ambulate independently. Conclusions:In patients with arterial insufficiency and severe soft-tissue wounds, combined vascular reconstruction and free-tissue transfer permits extended limb salvage with excellent functional results. (J VASC SURG 1993;18:972-80.) Limb-threatening, lower extremity soft-tissue wounds are a frequent manifestation of arterial occlusive disease. Successful arterial bypass alone is insufficient for complete lower extremity reconstruction in patients with exposed tendon or bone proximal to the metatarsal-phalangeal joints. Before the advent of free-tissue transfer, these severely ischemic wounds of the distal leg, ankle, and foot were treated with amputation. Combined vascular reconstruction with free-tissue transfer (VR-FTT) for coverage of these wounds permits extended limb salvage.

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Section: Discussionmentioning

confidence: 55%

Extension of limb salvage by combined vascular reconstruction and adjunctive free-tissue transfer

Serletti¹,

Hurwitz²,

Jones³

et al. 1993

Journal of Vascular Surgery

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“…7,8 The greater omentum-long been known as the "watchdog of the abdomen"-has been used as a pedicled graft for intra-abdominal purposes, for sternal defect cover in the instance of mediastinitis after sternotomy [9][10][11][12][13][14][15][16][17] or wounds after mastectomy, 18 and also in various other areas, including the lower extremity when transferred as a microvascular free flap. [19][20][21][22] When the need for a laparotomy with all inherent abdominal complications can be avoided through laparoscopic harvest, the greater omentum could become a worthwhile alternative within the armamentarium of leg salvage surgery.…”

mentioning

confidence: 99%

The nutrient omentum free flap: Revascularization with vein bypasses and greater omentum flap in severe arterial ulcers

Horch

Horbach

Lang

2007

Journal of Vascular Surgery

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Microvascular transfer of the omentum provides well-vascularized and pliable tissue but has not widely been used in vascular extremity reconstruction because of the potentially high donor site morbidity caused by the necessary laparotomy. Laparoscopic minimally invasive harvest of a free greater omentum flap and microsurgical transfer of this tissue with split skin grafts on top and connected to sequential vein bypasses may be a an interesting new modality when other reconstructive options are absent or scarce. We report this novel technique in a patient with arterial occlusive disease and an extensive and circular ulcer of the lower extremity.

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“…When particularly large wounds are present, healing may be accelerated by a variety of procedures, including local pedicled flaps, skin grafting, free flaps and even omental free grafts. [29][30][31] In selected cases, these procedures may dramatically shorten the recovery period and improve quality of life in a group of patients with a limited life expectancy.…”

Section: Management Of Tissue Lossmentioning

confidence: 99%

Review: The management of tibial artery disease in diabetes

Torella

Ashleigh

Bolia

et al. 2002

Diabetes & Vascular Disease

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F oot ulceration and gangrene are important causes of morbidity in diabetic patients. Healing of such lesions requires surgical debridement of the infected and necrotic tissue, and restoration of pulsatile blood flow to the foot. As occlusive atherosclerosis of the tibial arteries is particularly common in diabetic patients, infrapopliteal revascularisation is often required. This has traditionally been accomplished by transluminal angioplasty or surgical bypass, with moderately good results. More recently, subintimal angioplasty has been proposed as an alternative, minimally invasive treatment to recanalise long arterial occlusions, with promising patency rates even in small vessels. Advanced reconstructive techniques, including local or free tissue flaps can be used to accelerate healing of large foot wounds after successful revascularisation. Treatment of diabetic tibial artery disease is challenging and requires an aggressive multidisciplinary approach, with co-operation between diabetologists, interventional radiologists, vascular and plastic surgeons.

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Revascularization of the Lower Extremity with Omentum

Cited by 19 publications

References 9 publications

Extension of limb salvage by combined vascular reconstruction and adjunctive free-tissue transfer

Extension of limb salvage by combined vascular reconstruction and adjunctive free-tissue transfer

The nutrient omentum free flap: Revascularization with vein bypasses and greater omentum flap in severe arterial ulcers

Review: The management of tibial artery disease in diabetes

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