Scrotal reconstruction with a free greater omental flap: A case report

Summary:Lymphedema is a chronic debilitating disease, affecting a considerable part of the population; it results from impairment of the lymphatic system. It is highly prevalent among patients subjected to axillary and groin nodal dissection after surgery for breast cancer, abdominopelvic surgery, and lymphadenectomy after melanoma surgery. Interestingly, among the surgical treatment options for lymphedema, groin lymph node transfer is gaining popularity; however, in some cases, dissection at this site can cause significant morbidity, including possible development of iatrogenic lymphedema. To avoid these complications, new donor nodal groups are being proposed (eg, submental or supraclavicular). We have used the greater omentum as a lymph node and lymph vessel donor site. Dissection of the omentum is easy to perform and can even be done in patients who have undergone previous abdominal surgeries. We present refinements in the surgical technique for free omentum transfer in the management of secondary lymphedema: the first free omental flap dissection performed laparoscopically and the use of a primary flap as the recipient pedicle of a free greater omentum flap for anatomical repair after chest osteoradionecrosis and simultaneous functional repair of chronic lymphedema.

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“… 4 The omentum can be exteriorized and lengthened based on a vascular pedicle or detached using microvascular anastomosis. 5 – 7 …”

Section: Discussionmentioning

confidence: 99%

New Refinements in Greater Omentum Free Flap Transfer for Severe Secondary Lymphedema Surgical Treatment

Lasso¹,

Pinilla²,

Castellano³

2015

Plastic and Reconstructive Surgery - Global Open

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“…32,33 Laparotomically or laparoscopically harvested omental flaps have been used for reconstructive surgery of superficial extra-abdominal structures. For instance, they have been used to treat large scalp defects, 34 sternal wound infections after sternotomy for coronary artery bypass grafting, 35 scrotal reconstruction, 36–38 soft tissue augmentation of breasts 39 and facial contour defects. 40,41 In rats, fragmented omental tissues, with or without cotransplantation with preadipocytes, have been proved potentially useful for soft tissue augmentation.…”

Section: Discussionmentioning

confidence: 99%

Decellularized omentum as novel biologic scaffold for reconstructive surgery and regenerative medicine

et al. 2013

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Homologous tissues, such as adipose tissue, may be an interesting source of acellular scaffolds, maintaining a complex physiological three-dimensional (3D) structure, to be recellularized with autologous cells. The aim of the present work is to evaluate the possibility of obtaining homologous acellular scaffolds from decellularization of the omentum, which is known to have a complex vascular network. Adult rat and human omenta were treated with an adapted decellularization protocol involving mechanical rupture (freeze-thaw cycles), enzymatic digestion (trypsin, lipase, deoxyribonuclease, ribonuclease) and lipid extraction (2-propanol). Histological staining confirmed the effectiveness of decellularization, resulting in cell-free scaffolds with no residual cells in the matrix. The complex 3D networks of collagen (azan-Mallory), elastic fibers (Van Gieson), reticular fibers and glycosaminoglycans (PAS) were maintained, whereas Oil Red and Sudan stains showed the loss of lipids in the decellularized tissue. The vascular structures in the tissue were still visible, with preservation of collagen and elastic wall components and loss of endothelial (anti-CD31 and -CD34 immunohistochemistry) and smooth muscle (anti-alpha smooth muscle actin) cells. Fat-rich and well vascularized omental tissue may be decellularized to obtain complex 3D scaffolds preserving tissue architecture potentially suitable for recellularization. Further analyses are necessary to verify the possibility of recolonization of the scaffold by adipose-derived stem cells in vitro and then in vivo after re implantation, as already known for homologus implants in regenerative processes.

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“…In the past decades, a vast amount of techniques have been proposed for defect coverage in this complex region. Most of them consist of split‐ or full‐thickness skin grafts and local or free flaps , which may result in additional scars and reveal a less‐than‐ideal final cosmetic appearance. Skin grafts tend to contract, and because of the lack of surrounding soft tissue, they offer less protection to the testicles, leading to further patient discomfort .…”

Section: Discussionmentioning

confidence: 99%

“…Local or free flaps have the advantage of reduced contraction, increased durability and upholstering; however, they often lack pliability. They can cause considerable donor‐site morbidity and alter the natural appearance of the genital region . The genital region is a sensitive region for patients; therefore, unsatisfactory functional and aesthetic results may cause serious psychological issues such as a low self‐esteem and even social withdrawal.…”

Section: Discussionmentioning

confidence: 99%

“…The best outcomes are achieved by replacing damaged tissue with similar tissue (‘like with like’) . Many reconstructive procedures have been proposed for this complex region, predominantly consisting of skin grafts, testicular relocations and miscellaneous local or free flaps, with their individual advantages and disadvantages . However, only few provide long‐term aesthetic appeal with minimal scarring.…”

Section: Introductionmentioning

confidence: 99%

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The versatility of the medial thigh lift for defect coverage in the genito‐perineal region

Djedovic

Frari

Matiasek

et al. 2016

International Wound Journal

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Soft tissue defects in the genito-perineal region are predominantly because of trauma, infections, neoplasms or iatrogenic causes. As a result of the region's urological, reproductive and gastrointestinal function, defects in this area may cause devastating physical and psychological consequences as well as diminished sexual functioning. The purpose of this study was to examine the efficacy of implementing a medial thigh lift for defect coverage in the perineal region. A retrospective analysis of all medial thigh lift procedures for defect coverage in the genito-perineal region between November 2010 and March 2015 was conducted at three institutions. Ten consecutive patients underwent a medial thigh lift for defect coverage in the genito-perineal region. Nine patients were male, and one was female. The causative factors were Fournier's gangrene in eight patients, one patient had a straddle injury, and one suffered from extramammary Paget's disease. The mean follow-up time was 19·8 months. The average total defect size was 11·1 × 11 cm (length × width). The medial thigh lift procedure is a safe, technically easy and reliable technique with discrete scars. Outstanding aesthetic and functional outcomes result in a high rate of patient satisfaction. Through immediate wound closure, a reduction of recovery time can be achieved.

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Scrotal reconstruction with a free greater omental flap: A case report

Cited by 10 publications

References 13 publications

New Refinements in Greater Omentum Free Flap Transfer for Severe Secondary Lymphedema Surgical Treatment

New Refinements in Greater Omentum Free Flap Transfer for Severe Secondary Lymphedema Surgical Treatment

Decellularized omentum as novel biologic scaffold for reconstructive surgery and regenerative medicine

The versatility of the medial thigh lift for defect coverage in the genito‐perineal region

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