Omental flap for treatment of long standing lymphoedema of the lower limb: can it end the suffering? Report of four cases with review of literatures

Abstract

We report our experience of four cases of long-standing unilateral, secondary lymphoedema of the lower limb, for which conservative treatment has failed, that were treated in our centre using pedicled omental flap. The four patients were followed for a period of 1 year after the procedures and frequent measurements of the circumference of the affected limb revealed a reduction in the circumference ranging between 50% in the first patient to 75% in the fourth patient together with an excellent functional improvement in terms of resuming walking, daily activities, sports and work. We think that pedicled omental flap is an important, relatively easy and safe option that deserves consideration in refractory cases of lymphoedema of the lower limb.

Double vascularized omentum lymphatic transplant (VOLT) for the treatment of lymphedema

“…This approach resulted in an iatrogenic hernia, which led to some severe complications, and limited widespread adoption of this technique . The advent of microsurgery has reignited interest in the omentum flap, as this approach would allow transplantation to virtually anywhere in the body, and the abdomen to be closed completely . Although laparoscopic harvest of the omentum has also been described, in our experience open harvest through a limited incision is more precise and remains the preferred approach.…”

“…Vascularized omentum lymphatic transplant (VOLT) is a promising technique in the surgical treatment of lymphedema . The omentum contains an abundant supply of lymphatic tissue over a large surface area, making it a viable option for lymphatic reconstruction, especially for patients who have limited peripheral donor site options because of prior surgery, and radiation.…”

Diagnosis and Prevention of Lymphocyst

“…Saad et al selected 4 patients with persistent lower limb lymphedema and invalid conservative treatment to perform omentoplasty. 13 The lymphedema of the 4 patients were improved significantly after operation.…”

Vascularized lymph node transfer for treatment of extremity lymphedema: An overview of current controversies regarding donor sites, recipient sites and outcomes

“…19,56 Previous studies using the GOLF reported an improvement in circumferential difference from 2% to 29%, 57 circumferential reduction rate between 9% and 22.2% for upper extremity lymphedema, 58 and from 50% to 75% for lower extremity lymphedema. 59 Recently, Nguyen et al reported the long-term outcome of 42 patients who underwent GOLF with a mean improvement in volumetric difference of 22% and good subjective improvements. 61 However, limited long-term data are available regarding the sequelae following GOLF harvest, particularly on digestion and intraperitoneal immune maintenance.…”