Laparoscopically harvested omental flap: results for 96 patients
Tóm tắt
Recent advances in endoscopic surgery have allowed laparoscopic harvesting of the omental flap with minimal deformity of the donor site. This study aimed to assess the safety and long-term complication rate for laparoscopic harvest of the omental flap (LHOF). From April 2002 to December 2008, 96 patients underwent LHOF for immediate reconstruction after breast cancer surgery. All the patients were evaluated for operating time, length of hospital stay, and the short- and long-term complications associated with LHOF. The omental flap was harvested successfully in 95 of 96 cases, and the total success rate for harvesting of the omental flaps was 99% without conversion to open surgery. The median operative time for harvesting of the omental flap was approximately 1 h. Five cases of partial graft necrosis (5.2%) and two cases of vascular injury (2.1%) to the gastroepiploic artery and vein occurred, and the graft survival rate was 96.8% (93 of 95 cases). Laparoscopy-associated complications occurred in eight cases (8.3%), including one incisional hernia. As a safe and minimally invasive procedure, LHOF has a low incidence of short- and long-term complications. This technique can expand the indications and usefulness of the omental flap.
Tài liệu tham khảo
Lieberman-Meffert D, White H (1983) The greater omentum: anatomy, physiology, pathology, surgery, with a historical survey. Springer, New York
Kiricuta I (1963) L’emploi dugrand epiploon dans la chirurgie du sein cancereux. Press Med 71:15–17
Kiricuta I, Goldstein AM (1972) The repair of extensive vesicovaginal fistulas with pedicled omentum: a review of 27 cases. J Urol 108:724–727
Goldsmith HS (1990) The omentum: research and clinical applications. Springer, New York
Salz R, Stowers R, Smith M, Gadacz TR (1993) Laparoscopically harvested omental free flap to cover a large soft tissue defect. Ann Surg 217:542–546
Cothier-Savey I, Tamtawi B, Dohnt F, Raulo Y, Baruch J (2001) Immediate breast reconstruction using laparoscopically harvested omental flap. Plast Reconstr Surg 107:1156–1163
Nishimura T, Kanehira E, Tsukatani T, Furukawa M (2002) Laparoscopically harvested omental flap for head and neck reconstruction. Laryngoscope 112:930–932
Ferron G, Garrido I, Martel P, Gesson-Paute A, Classe JM, Letourneur B, Querleu D (2007) Combined laparoscopically harvested omental flap with meshed skin grafts and vacuum-assisted closure for reconstruction of complex chest wall defects. Ann Plast Surg 58:150–155
Zaha H, Inamine S, Naito T, Nomura H (2006) Laparoscopically harvested omental flap for immediate breast reconstruction. Am J Surg 192:556–558
Cartier R, Brunette I, Hoshimoto K, Bourne WM, Schaff HV (1990) Angiogenic factor: a possible mechanism for neovascularization produced by omental pedicles. J Thorac Cardiovasc Surg 99:264–268
Beelen RHJ (1991) The greater omentum: physiology and immunological concepts. Neth J Surg 43:145–151
Liebermann-Meffert D (2000) The greater omentum: anatomy, embryology, and surgical applications. Surg Clin North Am 8:275–293
Yasuura K, Okamoto H, Morita S, Ogawa Y, Sawazaki K, Seki A, Matsumoto H, Matsuura A, Maseki T, Torii S (1998) Results of omental flap transposition for deep sternal wound infection after cardiovascular surgery. Ann Surg 41:455–459
Arnold PG, Irons GB (1981) One-stage reconstruction of massive craniofacial defect with gastroomental flap. Ann Plast Surg 6:26–33
Garderen Van, Wiggers TH, Van Geel AN (1991) Complications of the pedicled omentoplasty. Neth J Surg 43:1171–1174
Obaid SI, Morris DJ (2001) Laser Doppler perfusion imager use in incisional hernia repair following omental breast reconstruction. Plast Reconstr Surg 109:2006–2008
Contant CME, Van Geel AN, Van der Holt B, Wiggers T (1996) The pedicled omentoplasty and split skin graft (POSSG) for reconstruction of large chest wall defect: a validity study of 34 patients. Eur J Surg Oncol 22:532–537