Soft tissue reconstruction with omental free flap in complex upper extremity injuries: Report of 13 cases

Abstract

Although there is a wide list of free flaps options for soft tissue reconstruction of complex upper extremity injuries, the omental flap has some useful anatomical and biochemical advantages. We report 13 patients who underwent hand or upper extremity reconstruction with omental free flaps. Nine patients had extensive tissue damage, resulting with digital cyanosis and hypothermia, and some of them with areas of cutaneous necrosis, or avulsed tissues with tendons and bones exposed or infected. The remaining four patients had minor extensive tissue damage without circulatory problems. Patient's average age was 34.6 years. Twelve flaps were harvested through laparotomy and one laparoscopically. All flaps were covered with a skin graft. None of the flaps were lost. The average follow-up time was 20 months. There was one major and two minor donor site complications. One patient had minor loss of the skin graft in the recipient site, and two required minor additional surgeries to improve the appearance or function of the hand or upper extremity. There were no late abdominal complications in any patient. The morphological appearance and functional results were favorable in 11 of them, and permitted their reincorporation into society without the need for additional complex surgeries. Only two patients had a poor outcome. Our experience confirms that the omental flap may be a good option for reconstruction of some complex hand and upper extremity injuries.

The laparoscopic right gastroepiploic lymph node flap transfer for upper and lower limb lymphedema: Technique and outcomes

“…The omental flap is known to house an extensive network of lymphatics vesels and nodes, and it has been described as a free or pedicled flap for complex reconstructions . Its anatomical, physiological and immunologial properties potentially lend it well to the treatment of lymphedema .…”

Soft tissue free flap for reconstruction of upper extremities: A meta‐analysis on outcome and safety

“…While the total flap loss rate ranged from 0 to 17% (Giesen, Forster, Künzi, Giovanoli, & Calcagni, ; Iglesias et al, ; Kong et al, ; Spindler et al, ; Wang, Fletcher, Erdmann, & Levin, ), the arterial thrombosis rate ranged from 0 to 25% (Giesen et al, ; Hing, Buncke, & Alpert, ; Spindler et al, ; Wang et al, ; Wang et al, ; Zheng, Liu, Dai, & Schilling, ). For microsurgical reconstruction of the lower extremity, Xiong et al recently published a meta‐analysis demonstrating an overall rate of total flap loss, thrombosis, and partial necrosis of 6% (Xiong et al, ).…”

The Omental Free Flap—A Review of Usage and Physiology

“…A recent case series demonstrates the use of the free flap in complex injuries of the upper extremity, showing favorable results in the reconstruction of complex wounds secondary to trauma, infection, chemotherapy extravasation, tumor resection, and burn. 76 The pliability and angiogenic properties make the tissue an attractive option for the treatment of nerve injuries, including brachial plexus lesions and carpal tunnel syndrome. Brachial plexopathy is a known complication of radiation to the axillary region, performed for carcinoma of the breast, lymphoma, or other cancers.…”