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We report a comorbid patient after redo Frozen Elephant Trunk procedure followed by recurrent infection of thoracic aortic prosthesis, deep sternal wound infection and extensive soft tissue defect. Closure with skin-muscle thoracodorsal flap and graft-sparing technique with omentoplasty is an alternative to total graft replacement for thoracic aortic graft infection in comorbid patients with concomitant extensive defect of the chest wall or recurrent infection in early postoperative period.

Objective: To assess the possibilities of omentoplasty for prevention of complications after redo sternum osteosynthesis for traumatic rupture., Material and Methods: The study included 53 patients with recurrent sternal diastasis. Greater omentum was additionally implanted in 19 (35.8%) cases to improve healing and reduce the risk of infectious complications. In 34 patients, redo osteosynthesis was carried out using a metal wire and deployment of irrigation-aspiration system. In 19 patients, omentoplasty was additionally used to close the wound., Results: Omentoplasty was characterized by less duration of lavage (7.4±1.5 vs. 4.2±3.3 days, p <0.0001) and no cases of arrosive bleeding ( p =0.04)., Conclusion: Omentoplasty reduces duration of treatment and risk of arrosive bleeding.

Aim: To present an experience of laparoscopic-assisted harvesting of omental flap in chest wall reconstruction for deep sternal wound infection., Material and Methods: It was made a prospective analysis of 14 patients aged 39-85 years after laparoscopic-assisted harvesting of omental flap in chest wall reconstruction for the period December 2014 - November 2016. Men/women ratio was 10/4. All patients had deep sternal wound infection grade IV (Oakley-Wright classification)., Results: Postoperative complications were observed in 2 (14.3%) of 14 (95% CI: 4.0-39.9%) cases that did not require re-operation. There were no 30-day postoperative mortality and significant complications as acute intestinal obstruction, postoperative ventral herniation and transplant rejection. Mean postoperative hospital-stay was 10.5 (9; 13) days., Conclusion: Laparoscopic-assisted harvesting of omental flap is safe method for chest wall reconstruction in patients with severe sternal wound infection associated with soft tissue deficiency and high risk of local complications (bleeding, etc.). Laparoscopy significantly reduces incidence of postoperative complications after omental flap transposition and is feasible in majority of patients.

The experimental group consisted of 91 rabbit. Using laser Doppler flowmetry the microcirculation was measured in the gastric sero-muscular flap after its implantation to the kidney or liver wound. The same characteristics were measured in the omental flap after kidney wound plasty. The observation time was from the day of implantation up to 360 days. The study demonstrated, that microcirculation in the gastric flap was equal and even during the whole observation time. The microcirculatory parameters in the omental flap were, on the contrary, uneven, decreasing distally. The studied parameters were higher in gastric flap, then in the omental. Therefore, tissue regeneration was much better with the use of gastric flap plasty in comparison with omentum, various biomaterials and routine organ suturing.

In 52 rabbits a morphological assessment was made of regeneration of wounds of the liver and kidneys after their plasty with a seromuscle flap of the stomach on the vascular pedicle (26 rabbits), of hepatorhaphy and omentonephroplasty (26 rabbits) within the period from 1 to 360 days and was compared with literature data concerning reparation of the liver and kidney of the rabbit with the application of bio- and polymer materials for covering their wounds. The influence of plastic properties of the materials used on the productivity of the inflammatory-reparative process was established. In suturing the wounds of parenchymatous organs it is necessary to use plastic materials stimulating regeneration. The application of seromuscle flap of the stomach for these purposes improves the inflammatory-reparative process making it more productive as compared with bio- and polymer materials.

The experience of 34 operations of omental implantation to the patients with the critical lower limb ischemia due to the obliterative thrombangiitis was analyzed. 5 patients had the procedure on the both limbs simultaneously. The operative technique had been thoroughly described in the article. The procedure, being accomplished according to the certain standards, proved to be extremely effective.

Presented herein are favourable outcomes of surgical management in six patients suffering from thromboangiitis obliterans (TO) with accompanying critical ischaemia of either the both lower extremities (5 subjects) or the both upper limbs (1 patient). They were all treated by means of a surgical intervention with simultaneous transplantation of the greater omentum on a vascular pedicle onto the both limbs. A total of 12 revascularizing procedures were performed. With an overall of the 12 extremities eventually spared, the remote limb-salvage rate amounted to 100%. A detailed description of the procedural technique is followed by analysing long-term therapeutic outcomes having proved encouraging. The obtained results confirmed a possibility of reliably relieving critical ischaemia inpatients with TO by means of transplanting the greater omentum on a vascular pedicle simultaneously onto the both limbs.

The authors are sharing their five-year experience gained at the Department of Vascular Surgery of the Samara State Medical University in performing microsurgical autotransplantation of the greater omentum to a lower extremity in patients presenting with critical ischaemia accompanied by thromboangiitis obliterans. A total of twenty-five operations of microsurgical autotransplantation of the greater omentum on a vascular pedicle were carried out in twenty patients diagnosed with lower limb critical ischaemia accompanied by thromboangiitis obliterans, for five of them underwent surgery simultaneously on the both lower extremities. With an overall number of 22 extremities eventually spared, the remote limb-salvage rate amounted to 88%. The preoperative preparation procedures as well as surgical technique are discussed in detail.

The revascularizing properties of the greater omentum used as a vascular pedicle for the prefabrication of skin, skin/cartilage or skin/ bone autografts, and their viability after rotation and recipient zone infection were studied in rat experiments. The experiment showed that complexity factor did not have a significant effect on the revascularizing properties of the greater omentum, and required only an insignificant prolongation of prefabrication period. Skin/omental, skin/cartilageous, and skin/bony autografts based on the greater omentum formed by day 7, 14, and 21, respectively. After these periods prefabricated autografts remained viable upon rotation. In case of infection, the survival rate of prefabricated skin/bone autografts, revascularized with two-layer greater omentum, is lower than that of skin/cartilage ones. The technique of prefabrication of autografts including skin, cartilage, and bone, is a promising method for closure of vast multicomponent defects in complicated clinical situations.

Seven-year experience in the treatment of 21 patients with chronic osteomyelitis of the ribs and sternum is summarized. Great omentum was used as plastic and disinfecting material in combination with laser radiation. Indications, techniques, short- and long-term results are presented. There were no recurrences of purulent process in the bones. Omentoplasty is the method of choice in surgical treatment of purulent lesions of costal cartilage and sternum.

In vascular surgery department of V.V. Vakhidov Research Center of Surgery prolonged intraarterial catheter therapy (PIACT) was applied in the treatment of 97 patients with critical lower limbs ischemia. Both routine and special methods of examination were used. Isolated PIACT was performed in 29 patients, PIACT in combination with other operations--in 68 patients (lumbar sympathectomy--51, microsurgical transplantation of greater omentum--9, arterialisation of venous system--8). Good and satisfactory results were achieved in 82.4% patients, limb amputations were performed in 17.6% patients. PIACT is most effective only in combination with other surgical methods. Use of PIACT in acute limb ischemia is not recommended.

There was the technique elaborated for the revascularized transplantation of the omentum majus flap on myocardium, upper extremity and brain. There were performed 26 operations of nondirect revascularization of myocardium, 3--of microsurgical transplantation on upper extremity and 3--on the brain.

Anatomo--morphological peculiarities of greater omentum (GO) in 63 patients, in whom its flap was applied for revascularization of ischemized tissues of extremities, myocardium and the brain, were studied up. Microsurgical transplantation of the GO free flap was performed in 41 patient, omentocardiopexy without the break of the GO vascular pedicle--in 22. Possibilities of the GO application for the ischemized organs revascularization were estimated.

The author presents results of a topographo-anatomical investigation aimed at studying and proving the optimum way of dislocation of a greater omentum flap into the pleural cavity in order to improve processes of regeneration of the bronchus stump. A flap of the omentum with the saved right gastro-omental artery was used. The esophageal foramen of the diaphragm, right sternocostal triangle were considered as possible ways of dislocation as well as the artificially made foramina in the tendinous center of the right half of the diaphragm.

The purpose of the study was to record somatosensory evoked potentials (SSEP) to objectify the results omentomyelopexy in late spinal cord injury. SSEP were recorded in 25 patients in leads of three levels of the somatosensory tract (from the popliteal fossa, from the lumbar enlargement of the spinal cord, and from the surface of the skull in the region of projection of leg presentation in cerebral hemispherical cortex) before and after surgery. The study indicated that there were no pre- or postoperative records of cortical evoked potentials. At the same time there was improvement in the magnitude of SSEP at the level of the lumbar enlargement (36%). In 4 (16%) and 5 (20%) cases of them SSEP changes were clear and unclear, respectively. The assessment of SSEP changes requires consideration of cases with unclear SSEP. Comparison of the results with clinical findings shows a correlation mainly with urological and urodynamic evidence. Thus, there are minor positive changes in the magnitude of SSEP after omentomyelopexy in the lumbar enlargement lead with unclearly pronounced evoked potentials.

The results of surgical treatment of 9 patients with bronchial fistulas after pneumonectomy have been analysed. During the reoperation the bronchial stump was wrapped by the omental flap with vascular pedicle (omentoplasty). In 6 patients omentoplasty was used in urgent repeated transpleural operations, in 3--during the late operations from transsternal transpericardial approach. Wedge resection of the tracheal bifurcation with omentoplasty from transsternal transpericardial approach was performed in 2 patients with a short bronchial stump. 2 patients died after surgery: one--from cardiopulmonary failure, the other one--from the relapse of bronchial fistula. Omentoplasty in patients with primary bronchial fistulas proved to be effective. It is advisable to perform reoperations during the 1st day after complications developed.

The results of omental transplantation to the site of spinal cord lesion in 40 patients in late injury are given. Neurological deficit was alleviated in 17.5% of patients. Improvement of segmentary functions was observed in most cases and was recorded within 1 week to 3 months postoperatively. There was no neurological improvement after 6 months postoperatively. Patients with mild spinal cord injuries (D10-L1) had the best outcomes. Comparative analysis of the outcomes of omentomyelopexy with those of treatment in 115 patients undergone meningomyeloradicolysis did not demonstrate any significant difference. Thus, it is not justifiable to use omental transposition in late spinal cord injury.

The purpose of treatment of head trauma cannot be limited by simple life saving, it also should be targeted at the improvement of the quality of life. Twenty dogs with graded local head trauma underwent microsurgical revascularization of the area adjacent to the contused brain with an autologous omental graft to provide functional improvement. The effectiveness of surgery was demonstrated in series of 5 experiments when the operation was performed on posttraumatic days 7-14, with the follow-up of as long as 180 days. After the procedure, no macroscopic signs of contusion could be demonstrated. Microscopically the contused area resembled a slit two times smaller than in controls. Microscopic and histochemical studies revealed both the morphologic recovery and an improvement in cellular enzyme activity. The data obtained adds some more information regarding clinical applications of microsurgical revascularization technique.

The plastic properties of the greater omentum cannot be used to a full measure in the existing methods of closure of perforating ulcers. The authors suggest a method of plastic repair of gastric and duodenal perforations with the greater omentum using a metal design with shape storage. The plastic properties of the greater omentum are used fully in the suggested method. The supply of blood in the area of the omentum placed into the stomach is maintained for 2-3 days after the operation. And later the blood supply to the region of the ulcerous defect improves due to the formation of anastomoses between the vessels of the omentum and the stomach. The obturation of the perforation is more reliable in this method than in Oppel-Polikarpov's method. The suggested method was tested in experiments with good results.

The paper deals with improvement of procedures for autografting a greater omental fragment to the vascular layer of the brain in its experimental ischemic lesions. The findings suggest that a functional vasculature has formed between the omentum and the meninx vasculosa just at hour 24 postautografting. This provides evidence to recommend the method for clinical application to compensate cerebral circulatory disorders in tumor-induced and vascular abnormalities in the brain.

A total of 37 patients with postoperative chronic osteomyelitis of the sternum and ribs which had developed after various operations on chest organs and 22 patients with residual pleural empyema developed after various lung operations were followed up. In patients from the both groups the first step, a thorough sanitation of infection foci, was performed; resection of diseased segments of the sternum and ribs in sternal and costal osteomyelitis and sanitation of the residual pleural cavity in residual pleural empyema. The second step was that defect of the anterior surface of the chest, which had developed after sternal and costal resection, was eliminated in the first group of patients as well as residual pleural cavity and bronchial fistula were removed in the second group. In the two groups, the following tissues were used as a plastic material: a greater omental flap (n = 27), the musculus rectus abdominis (n = 7), and musculus pectoralis major (n = 3) in Group 1, a greater omental flap (n = 8), the musculus pectoralis major (n = 9) and musculus latissimus dorsi (n = 5) in Group 2. In Group 1 a good therapeutical result was noted in 34 (91.1%) patients, a satisfactory one in 2 (6.2%). One (2.7%) patient died. It is concluded, that displacement of tissues on the fixed vascular pedicle is a valid method for eliminating tissue deficit in thoracic surgery.

Expanded (13) and combined (9) pneumonectomy with laparotomy and plastics of the bronchial stump with the greater omentum on a vascular pedicle were conducted on 22 patients in the period from 1988 (June) to 1990 (April). The omentum was used for the prevention of bronchial fistulas and correction of defects in the pericardium. Laparotomy and omentopexy did not aggravate the patients' condition essentially and did not affect the terms of treatment. A defect in the bronchial stump occurred only in 2 patients in the post-operative period and closed spontaneously in one of them.

The variants of operative tactics and technique of early microsurgical autoplasty of the extensive crushed and scalped wounds of the digits and hand in 15 patients are presented. Three main groups of the sufferers were distinguished: with scalping of the I digit, with crushing of the digits and a skin defect of the butt-end of a hand stump, with totally scalped wounds of the hand and low third of the forearm. The advantages of the use of reversed flaps of the forearm with suture of a sensory nerve in limited defects, and free transplant of the greater omentum in extensive wounds are shown.

The authors possess experience in surgical treatment of 29 patients with radiation damages of various localization. They compare the efficacy of various methods of plastic surgery of tissue defects, namely, autotransplantation of the greater omentum, transplantation of free tissue flaps, the use of transfer musculocutaneous flaps. The authors suggest a classification of the methods used and the indications for their application. Complete clinical recovery was achieved in 21 patients.

For the treatment of neurogenic dysfunctions of the urinary bladder resulting in residual urine and therefore the lack of adequate urination, the authors proposed the performance of omentovesicopexy due to which the damaged function could be partially compensated by intraperitoneal pressure. The greater omentum should be used for reinnervation and revascularization of the urinary bladder as it meets the requirements for the donor organ enabling the formation of competent indirect innervation due to its adequate mobility and size and the formation of the abdominal enclosure of the bladder when ascending to the abdominal cavity. Being a double layer of the peritoneum the greater omentum avoids transformation into the connective tissue thus contributing to "functional anastomosis" for a long time. The technique developed was successfully used in 12 surgeries for the patients with residual urine. The postoperative period was featured by the manifest equivalent of micturition urge, disappearance or a significant decrease in the amount of residual urine, restoration of spontaneous and controlled urination. The omentovesicopexy is a simple, efficient and available technique for usage by a wide range of urologists.

Free microsurgical autotransplantation of the greater omentum was performed in 24 patients with different pathologies. Dominant character of blood supply of the greater omentum from the right gastro-omental artery was detected as well as the interrelation between repeated arrests of blood supply in the transplant and frequency of necroses of the transplanted greater omentum.

Results of omentoplasty of residual cavities of the liver are described. New variants of operations of omentoplasty following hydatidectomy and abscessotomy gave good near and remote results of the treatment.