Use of the Omental Free Flap for Treatment of Chronic Anterior Skull Base Infections

Abstract

Summary: Chronic complications following anterior cranial fossa tumor extirpation, such as cerebrospinal fluid leak, meningitis, mucocele, pneumocephalus, and abscess, negatively impact patient quality of life. Robust vascularized tissue is generally required to adequately reconstruct and obliterate this complex geometric space. The aim of this study was to describe outcomes and advantages of the omental flap for these defects. Following institutional review board approval, a prospective, reconstructive database was reviewed from 2011 to 2020. Four patients with chronic anterior skull base complications treated with omental flap reconstruction were identified, with chart reviews performed. Median time from the index operation until the complication ultimately required a free omental transfer was 7.3 years. All patients underwent adjuvant radiation with the indications for surgery, including cerebral abscess, recurrent meningitis, osteomyelitis, and pneumocephalus. All free flaps survived without any need for revision. There were no donor site complications. One patient had delayed healing at an adjacent nasal wound that healed secondarily. At a median follow-up of 19.4 months, none of the patients had recurrent infections. The omental free flap has a number of properties, which make it ideally suitable for anterior skull base defects. Its malleable nature combined with the presence of multiple vascular arcades enable flexibility in flap design to contour to the crevices of 3-dimensional skull base defects. Although other free flaps are available to the plastic surgeon, the versatility and reliability of the omentum make it a first-line consideration for anterior skull base reconstruction.

Current Research on the Use of the Omental Flap in Breast Reconstruction and Post-Mastectomy Lymphedema: A Focus on Omental-Vascularized Lymph Node Transfer

“…The current use of the omentum in surgery extends to the specialties of general surgery, thoracic surgery, neurosurgery, vascular surgery, orthopedic surgery, urogenital surgery, and gynecologic surgery [ 7 ]. Specific to plastic surgery, the omental flap has been a source of donor tissue that facilitates the reconstruction of various anatomical locations including the head and neck, the extremities, locally in the abdominal cavity, and in various cases of advanced breast cancer [ 6 , 7 , 11 ]. In terms of breast cancer reconstruction, omental-based breast reconstruction was first described as an alternative to autologous reconstruction from the more traditional donor sites of the abdomen and thigh by Kirikuta in 1963 [ 9 , 10 ].…”