The Application of an Omentum Graft or Flap in Spinal Cord Injury

Abstract

Background: Spinal cord injury (SCI) causes a primary injury at the lesion site and triggers a secondary injury and prolonged inflammation. There has been no definitive treatment till now. Promoting angiogenesis is one of the most important strategies for functional recovery after SCI. The omentum, abundant in blood and lymph vessels, possesses the potent ability of tissue regeneration. Methods: The present work examines the efficacy of autologous omentum, either as a flap (with vascular connection intact) or graft (severed vascular connection), on spinal nerve regeneration. After contusive SCI in rats, a thin sheath of omentum was grafted to the injured spinal cord. Results: Omental graft improved behavior scores significantly from the 3rd to 6th week after injury (6th week, 5.5 ± 0.5 vs. 8.6 ± 1.3, p < 0.05). Furthermore, the reduction in cavity and the preservation of class III β-tubulin-positive nerve fibers in the injury area was noted. Next, the free omental flap was transposed to a completely transected SCI in rats through a pre-implanted tunnel. The flap remained vascularized and survived well several weeks after the operation. At 16 weeks post-treatment, SCI rats with omentum flap treatment displayed the preservation of significantly more nerve fibers (p < 0.05) and a reduced injured cavity, though locomotor scores were similar. Conclusions: Taken together, the findings of this study indicate that treatment with an omental graft or transposition of an omental flap on an injured spinal cord has a positive effect on nerve protection and tissue preservation in SCI rats. The current data highlight the importance of omentum in clinical applications.

Heterogeneity of adipose stromal vascular fraction cells from the different harvesting sites in rats

“…Interestingly, the omental graft or transposition of an omental flap on an injured spinal cord positively affects nerve protection and tissue preservation in spinal cord injury in a rat model. These results have been attributed to the omentum, abundant in blood and lymph vessels possessing the potent tissue regeneration ability (Fay et al, 2021).…”

Established and Emerging Therapies in Acute Spinal Cord Injury

“…92 Autologous omental transplantation has been proposed as a method to introduce blood-and lymph-rich tissue to injured spinal cord tissue. 93 Relatively small human trials in the 1990s showed continued viability of omental grafts in chronic SCI patients but failed to demonstrate objective functional improvement, and interest in its SCI treatment potential fell flat for a time. 94 However, omental transplant therapy has progressed in other clinical settings, including flap transposition on the brain surface for neovascularization and neurotrophic effects in epileptic or ischemic brain injury.…”

“…95 Interest in omental angiogenesis as a treatment for SCI has revived in recent years, and trials in rats have improved neural preservation, reduced injury cavity, and promoted neovascularization of the injured site. 93 A newer addition to the regenerative cellular therapies discussed in the literature is peripheral nerve derived stem cells (PNSCs). Spheroid forms of PNSCs have demonstrated therapeutic potential through neurotrophic factor release and extracellular matrix expression, leading to significant functional recovery, neuronal regeneration, and neuropathic pain reduction in animal models.…”

“…Autologous omental transplantation has been proposed as a method to introduce blood- and lymph-rich tissue to injured spinal cord tissue [ 93 ]. Relatively small human trials in the 1990s showed continued viability of omental grafts in chronic SCI patients but failed to demonstrate objective functional improvement, and interest in its SCI treatment potential fell flat for a time [ 94 ].…”

“…However, omental transplant therapy has progressed in other clinical settings, including flap transposition on the brain surface for neovascularization and neurotrophic effects in epileptic or ischemic brain injury [ 95 ]. Interest in omental angiogenesis as a treatment for SCI has revived in recent years, and trials in rats have improved neural preservation, reduced injury cavity, and promoted neovascularization of the injured site [ 93 ].…”