Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1982 Jun;195(6):756–765. doi: 10.1097/00000658-198206000-00012

The omentum: its use as a free vascularized graft for reconstruction of the head and neck.

M J Jurkiewicz, F Nahai
PMCID: PMC1352675  PMID: 7082067

Abstract

The experience at Emory University Affiliated Hospitals with transplantation of the greater omentum as a free revascularized graft in 18 patients is presented. In each instance, there was realization of the therapeutic objective, either 1) the amelioration of congenital or acquired somatic deformity (14 patients) or 2) the control of infection (4 patients). Because the omentum is a syncytium of blood vessels and a variable amount of fat within redundant leaves of peritoneal membrane laden with macrophages, it is a tissue that serves admirably its extended role as an extracelomic free transplant. The greater omentum has been used for this purpose in five patients with hemifacial atrophy (Romberg's disease); three patients with hemifacial microsomia (first and second branchial arch syndrome); two patients with extensive losses of the maxilla, palate, and face due to a shotgun blast; two patients with atrophy and facial growth arrest due to x-irradiation; and two patients with deformity of the jaw and neck following tumor resection. In three additional patients, the omentum was used to obliterate the dead space after debridement of an infected open frontal sinus following failure of conventional therapy. In one instance, a revascularized free graft of omentum was used to salvage a patient with an exposed irradiated carotid artery graft and skin flap failure following radical neck dissection. In these 18 patients, there were no intra-abdominal complications consequent to harvest of the omentum. In one patient afflicted with hemifacial atrophy, there was spotty necrosis of the overlying attenuated facial skin flap and limited fat necrosis. In the follow-up period of four months to seven years, there has been no instance of late resorption. The method is reliable and has considerable promise in reconstructive surgery.

Full text

PDF
761

Images in this article

758Fig. 1a.
on p.758
759Fig. 1b.
on p.759
760Fig. 2.
on p.760
761Fig. 3.
on p.761

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BEAHRS O. H., ADSON M. A. The surgical anatomy and technic of parotidectomy. Am J Surg. 1958 Jun;95(6):885–896. doi: 10.1016/0002-9610(58)90831-6. [DOI] [PubMed] [Google Scholar]
  2. Bostwick J., 3rd, Hill H. L., Nahai F. Repairs in the lower abdomen, groin, or perineum with myocutaneous or omental flaps. Plast Reconstr Surg. 1979 Feb;63(2):186–194. doi: 10.1097/00006534-197902000-00006. [DOI] [PubMed] [Google Scholar]
  3. Brown R. G., Nahai F., Silverton J. S. The omentum in facial reconstruction. Br J Plast Surg. 1978 Jan;31(1):58–62. doi: 10.1016/0007-1226(78)90017-6. [DOI] [PubMed] [Google Scholar]
  4. Goldsmith H. S., Beattie E. J., Jr Carotid artery protection by pedicled omental wrapping. Surg Gynecol Obstet. 1970 Jan;130(1):57–60. [PubMed] [Google Scholar]
  5. Jurkiewicz M. J., Arnold P. G. The omentum: an account of its use in the reconstruction of the chest wall. Ann Surg. 1977 May;185(5):548–554. doi: 10.1097/00000658-197705000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Jurkiewicz M. J., Bostwick J., 3rd, Hester T. R., Bishop J. B., Craver J. Infected median sternotomy wound. Successful treatment by muscle flaps. Ann Surg. 1980 Jun;191(6):738–744. doi: 10.1097/00000658-198006000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. KIRICUTA I. [The use of the great omentum in the surgery of breast cancer]. Presse Med. 1963 Jan 5;71:15–17. [PubMed] [Google Scholar]
  8. MONTGOMERY W. W. THE FATE OF ADIPOSE IMPLANTS IN A BONY CAVITY. Laryngoscope. 1964 Jun;74:816–827. doi: 10.1288/00005537-196406000-00005. [DOI] [PubMed] [Google Scholar]
  9. McLean D. H., Buncke H. J., Jr Autotransplant of omentum to a large scalp defect, with microsurgical revascularization. Plast Reconstr Surg. 1972 Mar;49(3):268–274. doi: 10.1097/00006534-197203000-00005. [DOI] [PubMed] [Google Scholar]
  10. Upton J., Mulliken J. B., Hicks P. D., Murray J. E. Restoration of facial contour using free vascularized omental transfer. Plast Reconstr Surg. 1980 Oct;66(4):560–569. doi: 10.1097/00006534-198010000-00009. [DOI] [PubMed] [Google Scholar]
  11. Wallace J. G., Schneider W. J., Brown R. G., Nahai F. M. Reconstruction of hemifacial atrophy with a free flap of omentum. Br J Plast Surg. 1979 Jan;32(1):15–18. doi: 10.1016/0007-1226(79)90053-5. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES