Omental flap transplantation for Wound healing
To explore the clinical effects of pedicled omental flap transplantation in repairing secondary rejection wounds after brain pacemaker implantation.
A retrospective observational study was conducted. From January to August 2021, 5 patients with secondary rejection wounds after deep brain stimulation implantation who met the inclusion criteria were admitted to the Wound Repair Center of Ruijin Hospital of Shanghai Jiao Tong University School of Medicine, including 3 males and 2 females, aged 56-69 years, with the wound developed at the pulse generator implantation site in the chest in 2 cases, at the connection site of the wire and electrode behind the ear in 2 cases, and at both the chest and the back of the ear in 1 case. All the wounds were repaired by pedicled omental flap transplantation. The wound area after debridement was 2-15 cm2. After the operation, wound healing and related complications (pain, infection, incisional hernia, omental flap necrosis, etc.) were observed. During follow-up, the recurrence of the wound was observed. The wounds of all 5 patients healed within 2 weeks after the operation, without related complications. During follow-up of 12-18 months, 1 patient got a recurrence of rejection wound behind the left ear 4 months after surgery and eventually had the brain pacemaker removed; the other 4 patients had no recurrence of wounds. Pedicled omental flap transplantation can repair the secondary rejection wounds after brain pacemaker implantation safely and effectively, with few postoperative complications 1).
A total of 14 patients presented with recurrent intracranial infection after craniotomy. The symptoms and signs included persistent fever, despite prolonged systemic broad-spectrum antibiotic administration and repetitive debridement of the dural space. They underwent reconstruction with an omental-free flap to cover the craniotomy defect. Microvascular anastomosis is usually performed between the gastroepiploic and superficial temporal vessels. Surgeries were performed in the chronic stages of infection, and the patients were reviewed and assessed for recurrence over the long term postoperatively.
Results: The postoperative course was uneventful, and flap survival was excellent in all patients. The patients were discharged with no evidence of wound discharge, and there were no reports of infection recurrence, flap failure, or donor site morbidity.
Conclusions: The use of a vascularized free omentum flap was effective in cases involving intractable cranial wound infection 2).
Five patients, with a mean age of 52 years (range, 24-71 years), who underwent omental flaps for the treatment of postoperative complications in spine tumor resections were retrospectively evaluated.
Results: Four of 5 patients underwent omental transposition after a mean of 15 months (range, 4-27) from the previous surgery because of dehiscence of the wound (all of them had cerebrospinal fluid leak: 1 transpleural and in 3 cases, associated with deep infection), whereas one patient underwent the omental flap procedure at the time of elective spinal surgery because of several contemporary risk factors for wound healing. At the time of discharge after a mean of 36 days (range, 23-53), all patients had well-healed surgical wounds with an acceptable structural and aesthetic result. One of the patients had ileus, requiring surgical lysis of abdominal adhesions 3 months after the omentum flap procedure. No other complications were observed.
Conclusion: Our data suggest that a pedicled omental flap is a viable option for the treatment of complicated spinal wounds, helping in the resolution of the infection and CSF leak 3).
A 65-year-old man with a 10-year history of recurrent meningioma. The patient had undergone multiple tumor resections, radiotherapy treatments, and reconstructive surgeries due to wound infection. After the third resection of the tumor and reconstruction with an omental flap, the tumor demonstrated rapid growth and lung metastasis. The final pathological diagnosis was anaplastic meningioma. Because the drastic change of the tumor was observed after omental flap transposition, we investigated the effect of the omentum on tumor cells and performed histopathological analyses of meningiomas using a mouse model. We found that meningioma cells have a high affinity to the omentum and show a growth advantage when co-cultured with adipocytes. Immunohistochemical staining revealed that meningioma cells adjacent to the omentum strongly expressed fatty acid-binding protein 4, a lipid transfer protein, in both mice and humans. The results suggest that tumor cells can receive lipid supply from omental adipocytes, and the surrounding tissues may induce tumor progression. We conclude that although omental tissue is an ideal material for reconstruction surgery, close follow-up is recommended in meningioma patients when used for cranioplasty 4).