1,158 results on '"Omentum transplantation"'
Search Results
2. Augmented anastomotic ureteral reconstruction using buccal mucosal graft, initial experience.
- Author
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Reyad AM, Abd Elhamed AM, Elsherief AM, Abdelhaleem HA, and Mahmoud TA
- Subjects
- Humans, Prospective Studies, Male, Female, Middle Aged, Adult, Urologic Surgical Procedures methods, Ureteral Obstruction surgery, Ureteral Obstruction etiology, Cohort Studies, Plastic Surgery Procedures methods, Omentum transplantation, Mouth Mucosa transplantation, Ureter surgery, Anastomosis, Surgical
- Abstract
Objective: To assess the augmented anastomotic ureteral reconstruction using buccal mucosal graft based on omental flap for managing ureteral stricture., Subjects and Methods: This prospective cohort study was conducted on 13 patients with ureteric strictures of different lengths secondary to Bilhalziasis, iatrogenic (post endoscopy) and post inflammatory etiology in upper and mid ureteral segments were treated with buccal mucosal patch grafts and The graft is fixed to the undersurface or the posterior surface of the omentum before doing graft anastomosis to the ureteral walls as to ensure the process of graft take sticky to the principles of tissue transfer. All patients were subjected to full history taking, clinical examination for assessment of pain, lower or upper urinary track symptoms and laboratory investigation (complete blood count, CRP, liver function test and kidney function test (serum urea and creatinine)., Results: The mean operative time was 148.85 min and mean hospital stay was 3 days. Mean blood loss was ranged from 20 to 210 ml and Stent was removed after 8-12 weeks. The mean follow up was 13 months, all patients had a non-obstructive RI value <0.7 with a non-obstructed drainage pattern on the diuretic renogram except one patient who had severe postoperative UTI necessitating nephrostomy tube insertion his drainage curve was plateau., Conclusion: BMG ureteroplasty is a valuable option for a carefully selected patient. The fixation of the graft on the back surface of the omentum allows for better anatomical reconstruction without any twisting to the omental pedicle., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- Published
- 2024
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- View/download PDF
3. Retromesenteric omental flap as arterial coverage in pancreaticoduodenectomy: A novel technique to prevent postpancreatectomy hemorrhage.
- Author
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Marique L, Codjia T, Dembinski J, Dokmak S, Aussilhou B, Jehaes F, Cauchy F, Lesurtel M, and Sauvanet A
- Subjects
- Humans, Female, Male, Retrospective Studies, Middle Aged, Aged, Adult, Pancreatic Neoplasms surgery, Postoperative Complications prevention & control, Postoperative Complications epidemiology, Postoperative Complications etiology, Treatment Outcome, Pancreaticoduodenectomy adverse effects, Pancreaticoduodenectomy methods, Postoperative Hemorrhage prevention & control, Postoperative Hemorrhage etiology, Omentum transplantation, Omentum surgery, Surgical Flaps transplantation, Surgical Flaps blood supply, Surgical Flaps adverse effects, Pancreatic Fistula prevention & control, Pancreatic Fistula etiology, Pancreatic Fistula epidemiology
- Abstract
Background: Clinically relevant postpancreatectomy hemorrhage occurs in 10% to 15% of patients after pancreaticoduodenectomy, mainly in association with clinically relevant postoperative pancreatic fistula. Prevention of postpancreatectomy hemorrhage by arterial coverage with a round ligament plasty or an omental flap is controversial. This study assessed the impact of arterial coverage with an original retromesenteric omental flap on postpancreatectomy hemorrhage after pancreaticoduodenectomy., Methods: This single-center retrospective study included 812 open pancreaticoduodenectomies (2012-2021) and compared 146 procedures with arterial coverage using retromesenteric omental flap to 666 pancreaticoduodenectomies without arterial coverage. The Fistula Risk Score was calculated. The primary endpoint was a 90-day clinically relevant postpancreatectomy hemorrhage rate according to the International Study Group of Pancreatic Surgery classification., Results: There were more patients with a Fistula Risk Score ≥7 in the arterial coverage-retromesenteric omental flap group: 18 (12%) versus 48 (7%) (P < .01). Clinically relevant postpancreatectomy hemorrhage was less frequent in the arterial coverage- retromesenteric omental flap group than in the no arterial coverage group: 5 (3%) versus 66 (10%), respectively (P = .01). Clinically relevant postoperative pancreatic fistula occurred in 28 (19%) patients in the arterial coverage- retromesenteric omental flap group compared with 165 (25%) in the no arterial coverage group (P = .001). There were fewer reoperations for postpancreatectomy hemorrhage or postoperative pancreatic fistula in the arterial coverage- retromesenteric omental flap group: 1 (0.7%) versus 32 (5%) in the no arterial coverage group (P = .023). In multivariate analysis, arterial coverage with retromesenteric omental flap was an independent protective factor of clinically relevant postpancreatectomy hemorrhage (odds ratio 0.33; 95% confidence interval [0.12-0.92], P = .034) whereas postoperative pancreatic fistula of any grade (odds ratio = 10.1; 95% confidence interval: 5.1-20.3, P < .001) was predictive of this complication., Conclusion: Arterial coverage with retromesenteric omental flap can reduce rates of clinically relevant postpancreatectomy hemorrhage after pancreaticoduodenectomy. This easy and costless technique should be prospectively evaluated to confirm these results., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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4. [Successful Closure of Postpneumonectomy Bronchopleural Fistula with Inserting Technique of Omental Pedicle Flap into the Right Main Bronchus:Report of a Case].
- Author
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Tanaka H, Kou Y, Yamazaki N, Sakaguchi Y, and Sonobe M
- Subjects
- Humans, Male, Aged, Lung Neoplasms surgery, Omentum transplantation, Omentum surgery, Postoperative Complications surgery, Bronchi surgery, Carcinoma, Squamous Cell surgery, Pneumonectomy methods, Bronchial Fistula surgery, Bronchial Fistula etiology, Surgical Flaps, Pleural Diseases surgery, Pleural Diseases etiology
- Abstract
A 67-year-old male was admitted to our hospital for the treatment of pyothorax due to bronchopleural fistula at right main bronchus after pneumonectomy for lung cancer( squamous cell carcinoma, pathological stageⅢB). After tube drainage and fenestration, we performed operation to close large diameter fistula, that was almost fully opened stump of the right main bronchus. Omental flap was sutured roughly to the fistula with four stiches and inserted into the bronchus lumen, and covered with latissimus dorsi muscle flap to fix omental pedicle flap and additionally performed thoracoplasty to close the residual space of the pleural cavity. Fistula at the stump became airtight after operation and pyothorax was cured, so our method was thought to be available to close large diameter bronchopleural fistula with omental pedicle flap.
- Published
- 2024
5. Mediastinal transposition of the greater omentum for treatment of infected prostheses of the ascending aorta and aortic arch.
- Author
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Pitts L, Pasic M, Wert L, Nersesian G, Kaemmel J, Buz S, Knosalla C, Düsterhöft V, Starck C, Kempfert J, Jacobs S, and Falk V
- Subjects
- Humans, Male, Female, Middle Aged, Aged, Retrospective Studies, Blood Vessel Prosthesis Implantation methods, Treatment Outcome, Adult, Tomography, X-Ray Computed, Omentum transplantation, Omentum surgery, Prosthesis-Related Infections surgery, Aorta, Thoracic surgery, Aorta, Thoracic diagnostic imaging, Blood Vessel Prosthesis adverse effects, Aorta surgery, Mediastinum surgery
- Abstract
Objectives: The aim of this study was to evaluate the outcomes of transposition of the omentum into the mediastinum to support the replacement of infected aortic grafts or to cover infected aortic grafts that are not amenable for surgical replacement., Methods: All patients with thoracic aortic graft infections who underwent mediastinal transposition of the omentum at our institution between 2005 and 2023 were included in this study. Mediastinal transposition of the omentum was performed either after replacement of the infected graft ('curative concept') or solely as bailout procedure by wrapping the infected graft ('palliative concept'). The diagnosis, including computed tomography scans during follow-up, was made according to the criteria of the Management of Aortic Graft Infection Collaboration., Results: The patient cohort consisted of 31 patients. Both in-hospital and 1-year mortality were 0% (n = 0) for the curative concept (n = 9) compared to 23% (n = 5) and 41% (n = 9) for the palliative concept (n = 22), respectively. There was no graft infection-associated death or recurrence of infection after 3 years in the curative group. Survival was 52% at 3 years in the palliative group, with freedom of infection in 59% of the patients (n = 13)., Conclusions: Transposition of the omentum and wrapping of the infected aortic prosthetic graft is a useful bailout strategy for patients who are ineligible for replacement of an infected aortic graft. However, mortality stays high. For radical treatment of aortic graft infections, it may prove an effective supportive therapy and represents an important tool in the armamentarium of cardiac surgeons., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
- Published
- 2024
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6. Pedicled omental flaps for complex wound reconstruction following surgery for primary spine tumors of the mobile spine and sacrum.
- Author
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Massaad E, Patel SS, Sten M, Shim J, Kiapour A, Mullen JT, Tobert DG, MacDonald S, Hornicek FJ, and Shin JH
- Subjects
- Humans, Male, Female, Middle Aged, Adult, Retrospective Studies, Aged, Spinal Neoplasms surgery, Omentum transplantation, Omentum surgery, Sacrum surgery, Plastic Surgery Procedures methods, Surgical Flaps
- Abstract
Objective: Surgery for primary tumors of the mobile spine and sacrum often requires complex reconstruction techniques to cover soft-tissue defects and to treat wound and CSF-related complications. The anatomical, vascular, and immunoregulatory characteristics of the omentum make it an excellent local substrate for the management of radiation soft-tissue injury, infection, and extensive wound defects. This study describes the authors' experience in complex wound reconstruction using pedicled omental flaps to cover defects in surgery for mobile spine and sacral primary tumors., Methods: A retrospective cohort analysis was conducted on 34 patients who underwent pedicled omental flap reconstruction after en bloc resection of primary sacral and mobile spine tumors between 2010 and 2020. The study focused on assessing the indications for omental flap usage, including soft-tissue coverage, protection against postoperative radiation therapy, infection management, vascular supply for bone grafts, and dural defect and CSF leak repair. Patient demographic characteristics, tumor characteristics, surgical outcomes, and follow-up data were analyzed to determine the procedure's efficacy and complication rates., Results: From 2010 to 2020, 34 patients underwent pedicled omental flap reconstruction after en bloc resection of sacral (24 of 34 [71%]) and mobile spine (10 of 34 [29%]) primary tumors, mostly chordomas. The patient cohort included 21 men and 13 women with a median (range) age of 60 (32-89) years. The most common indication for omental flap was soft-tissue coverage (20 of 34 [59%]). Other indications included protecting abdominopelvic organs for postoperative radiation therapy (6 of 34 [18%]), treating infections (5 of 34 [15%]), providing vascular supply for free fibular bone graft (1 of 34 [3%]), and repairing large dural defects and CSF leak (2 of 34 [6%]). The median (range) follow-up was 24 (0-132) months, during which 71% (24 of 34) of patients did not require additional surgery for wound-related complications. At last follow-up, 59% (20 of 34) had stable disease and 32% (11 of 34) had recurrence, had progression of disease, or had been discharged to hospice after treatment., Conclusions: The pedicled omentum is an effective local tissue graft that can be used for complex wound reconstruction and management of high-risk closures in primary spine tumors. This technique may have a lower rate of complications than other approaches and may influence surgical planning and flap selection in challenging cases.
- Published
- 2024
- Full Text
- View/download PDF
7. Torsion of wandering spleen, splenectomy and autotransplantation of splenic slices
- Author
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Georgakis Ioannis, Papouis George, Pegios Athanasios, Vasiouris Panagiotis, and Papamitsou Theodora
- Subjects
Wandering spleen ,Spleen torsion ,Splenectomy ,Omentum transplantation ,Pediatrics ,RJ1-570 ,Surgery ,RD1-811 - Abstract
The aim of this research is to highlight the peculiarity of the incident, to discuss the decision for the transplant splenic slices, and to present the positive results of this approach. The case includes a 14-year-old girl who was presented with atypical abdominal pain last year. Ultrasound imaging showed an abdominal mass in the left lower abdomen. Following that, a CT was performed where the wandering spleen was imaged. Doppler control revealed relatively good blood flow, but partial spleen stems rotation while blood tests revealed thrombocytopenia. However, during the surgical procedure, the spleen appeared 2 ½ times veering the axis of the vascular pedicle. The decision to splenectomy was made due to the presence of small clots during palpation of the vasculature, the appearance of thrombocytopenia, and the technically inadequate splenopexy due to the large vascular pedicle. Partial spleen auto-transplantation on the omental was subsequently carried out. The follow up provided satisfactory results in size and function. The wandering spleen has difficulty in its clinical diagnosis. Visual inspection could document the diagnosis. The suggested treatment is splenopexy, but in the decision for splenectomy, as in this case, with evidence of viable splenic tissue, the successful autotransplantation of splenic slices reduces the risk of splenectomy complications, such as the post-splenectomy sepsis.
- Published
- 2021
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8. The Vascularized Omentum Lymph Node Transfer - A Key Point in the Lymphedema Management.
- Author
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Bordianu A, Petre I, Bobircă A, and Bobircă F
- Subjects
- Humans, Female, Retrospective Studies, Treatment Outcome, Middle Aged, Aged, Surgical Flaps, Adult, Lymphedema surgery, Lymphedema etiology, Follow-Up Studies, Lymph Nodes transplantation, Omentum transplantation, Quality of Life, Breast Cancer Lymphedema surgery, Breast Cancer Lymphedema etiology, Breast Neoplasms surgery, Breast Neoplasms complications, Breast Neoplasms pathology
- Abstract
Background: As an increased number of women beat breast cancer worldwide, the breast cancer related lymphedema has gained more attention recently. The vascularized omentum lymph node transfer has been approached as an useful tool for advanced and recurrent cases. The purpose of the paper is to emphasize the advantages and disadvantages of this method. Materials and Methods: This retrospective study consists of 17 patients known with breast cancer related lymphedema who received vascularized omentum lymph node transfer. Data was recorded between January 2022 and January 2023. Patients diagnosed with secondary lymphedema stage II or III, unresponsive to previous microsurgical lymphovenous bypass were included. Results: The most prevalent affected site was the left upper limb (59%), where edema was mainly identified in the forearm (75%). Nevertheless, more than half of the subjects have previously received lymphaticovenous anastomosis. The correlation between the stage of lymphedema and the postoperative reduction of the volume of the affected limb was -0.26, the slope to reached -0.33, with an intercept value of 2.64. The follow-up period showed reduced upper limb volume and an improved quality of life. Conclusion: Through an experienced hand, this versatile flap brings hope to breast cancer survivors with lymphedema., (Celsius.)
- Published
- 2024
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9. Design of a vascularized synthetic poly(ethylene glycol) macroencapsulation device for islet transplantation.
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Weaver, Jessica D., Headen, Devon M., Hunckler, Michael D., Coronel, Maria M., Stabler, Cherie L., and García, Andrés J.
- Subjects
- *
ISLANDS of Langerhans transplantation , *POLYETHYLENE glycol , *NEOVASCULARIZATION , *MICROENCAPSULATION , *HYDROGELS , *LIGANDS (Biochemistry) - Abstract
The use of immunoisolating macrodevices in islet transplantation confers the benefit of safety and translatability by containing transplanted cells within a single retrievable device. To date, there has been limited development and characterization of synthetic poly(ethylene glycol) (PEG)-based hydrogel macrodevices for islet encapsulation and transplantation. Herein, we describe a two-component synthetic PEG hydrogel macrodevice system, designed for islet delivery to an extrahepatic islet transplant site, consisting of a hydrogel core cross-linked with a non-degradable PEG dithiol and a vasculogenic outer layer cross-linked with a proteolytically sensitive peptide to promote degradation and enhance localized vascularization. Synthetic PEG macrodevices exhibited equivalent passive molecular transport to traditional microencapsulation materials (e.g., alginate) and long-term stability in the presence of proteases in vitro and in vivo, out to 14 weeks in rats. Encapsulated islets demonstrated high viability within the device in vitro and the incorporation of RGD adhesive peptides within the islet encapsulating PEG hydrogel improved insulin responsiveness to a glucose challenge. In vivo , the implementation of a vasculogenic, degradable hydrogel layer at the outer interface of the macrodevice enhanced vascular density within the rat omentum transplant site, resulting in improved encapsulated islet viability in a syngeneic diabetic rat model. These results highlight the benefits of the facile PEG platform to provide controlled presentation of islet-supportive ligands, as well as degradable interfaces for the promotion of engraftment and overall graft efficacy. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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10. Mediastinitis after a cryopreserved allograft tracheal transplant treated by transposition of the major omentum.
- Author
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Gómez-Caro A, Benkirane T, Martinod E, and Berthet JP
- Subjects
- Allografts, Humans, Trachea surgery, Trachea transplantation, Transplantation, Homologous, Mediastinitis etiology, Mediastinitis surgery, Omentum transplantation
- Published
- 2022
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11. Cranial transposition and revascularization of autologous omentum: a novel surgical technique for resection of recurrent glioblastoma multiforme.
- Author
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Doron O, Chen T, Wong T, Tucker A, Costantino P, Andrews R, Langer DJ, and Boockvar J
- Subjects
- Humans, Neoplasm Recurrence, Local surgery, Surgical Flaps, Transplantation, Autologous, Glioblastoma surgery, Omentum blood supply, Omentum transplantation
- Abstract
Glioblastoma multiforme (GBM) patients continue to suffer a poor prognosis. The blood brain barrier (BBB) comprises one of the obstacles for therapy, creating a barrier that decreases the bioavailability of chemotherapeutic agents in the central nervous system. Previously, a vascularized temporoparietal fascial scalp flap (TPFF) lining the resection cavity was introduced in a trial conducted in our institution, in newly-diagnosed GBM patients in an attempt to bypass the BBB after initial resection. In this paper, we report on a new technique to bypass the BBB after re-resection and potentially to allow tumor antigens to be surveilled by the immune system. The study aims to assess the feasibility of performing a cranial transposition and revascularization of autologous omentum after re-resection of GBM. Laparoscopically harvested omental free flap was transposed to the resection cavity by a team consisting of neurosurgeons, otolaryngologists, and general surgeons. This was done as part of a single center, single arm, open-label, phase I study. Autologous abdominal omental tissue was harvested laparoscopically on its vascularized pedicle in 2 patients, transposed as a free flap, revascularized using external carotid artery, and carefully laid into the tumor resection cavity. Patients did well postoperatively returning to baseline activities. Graft viability was confirmed by cerebral angiogram. Omental cranial transposition of a laparoscopically harvested, vascularized flap, into the cavity of re-resected GBM patients is feasible and safe in the short term. Further studies are needed to ascertain whether such technique can improve progression free survival and overall survival in these patients., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
- Published
- 2022
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12. Flowthrough Omental Flap for Vascularized Lymph Node Transplant of the Lower Extremity.
- Author
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Lee BS, Granoff MD, Pardo J, Sun W, Critchlow JF, Tsai L, Upton J 3rd, and Singhal D
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- Aged, Chronic Disease, Female, Follow-Up Studies, Free Tissue Flaps blood supply, Humans, Lymph Nodes blood supply, Male, Middle Aged, Omentum blood supply, Retrospective Studies, Treatment Outcome, Free Tissue Flaps transplantation, Lower Extremity surgery, Lymph Nodes transplantation, Lymphedema surgery, Omentum transplantation, Plastic Surgery Procedures methods
- Abstract
Summary: Vascularized lymph node transplantation is a surgical approach for the treatment of chronic lymphedema. However, there is no clinical standard for flap placement nor vascular anastomoses. The authors propose a novel flowthrough configuration for an omental vascularized lymph node transplant in the popliteal space. To prepare the popliteal space for an omental free flap, the medial popliteal fat pad and medial head of the gastrocnemius muscle were debulked. Venous anastomoses were completed with vein couplers, joining the right gastroepiploic vein to the medial sural venae comitantes and the left gastroepiploic vein to the lesser saphenous vein. Arterial anastomoses were hand sewn, joining the right gastroepiploic artery to the proximal medial sural artery and the left gastroepiploic artery to the distal medial sural artery, to create the flowthrough configuration. A retrospective review of patients who underwent this procedure at a single institution was performed. Six patients with chronic lymphedema of the lower extremity underwent vascularized lymph node transplantation from June of 2019 to November of 2020. Five patients underwent at least 3 months of postoperative surveillance, with no postoperative complications reported. In this technique contribution, the authors describe a novel flowthrough configuration for an omental free flap to the popliteal space. The popliteal space offers an aesthetically favorable recipient location when appropriately prepared. The medial sural vessels are ideal recipient vessels for the flowthrough omental flap., Clinical Question/level of Evidence: Therapeutic, IV., (Copyright © 2022 by the American Society of Plastic Surgeons.)
- Published
- 2022
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13. Torsion of wandering spleen, splenectomy and autotransplantation of splenic slices.
- Author
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Ioannis, Georgakis, George, Papouis, Athanasios, Pegios, Panagiotis, Vasiouris, and Theodora, Papamitsou
- Subjects
SPLEEN ,SPLENECTOMY ,OPERATIVE surgery ,AUTOTRANSPLANTATION ,TORSION abnormality (Anatomy) ,SPLENIC rupture - Abstract
The aim of this research is to highlight the peculiarity of the incident, to discuss the decision for the transplant splenic slices, and to present the positive results of this approach. The case includes a 14-year-old girl who was presented with atypical abdominal pain last year. Ultrasound imaging showed an abdominal mass in the left lower abdomen. Following that, a CT was performed where the wandering spleen was imaged. Doppler control revealed relatively good blood flow, but partial spleen stems rotation while blood tests revealed thrombocytopenia. However, during the surgical procedure, the spleen appeared 2 ½ times veering the axis of the vascular pedicle. The decision to splenectomy was made due to the presence of small clots during palpation of the vasculature, the appearance of thrombocytopenia, and the technically inadequate splenopexy due to the large vascular pedicle. Partial spleen auto-transplantation on the omental was subsequently carried out. The follow up provided satisfactory results in size and function. The wandering spleen has difficulty in its clinical diagnosis. Visual inspection could document the diagnosis. The suggested treatment is splenopexy, but in the decision for splenectomy, as in this case, with evidence of viable splenic tissue, the successful autotransplantation of splenic slices reduces the risk of splenectomy complications, such as the post-splenectomy sepsis. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
14. Vascularized omental lymphatic transplant for upper extremity lymphedema: A systematic review.
- Author
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Jarvis NR, Torres RA, Avila FR, Forte AJ, Rebecca AM, and Teven CM
- Subjects
- Breast Neoplasms complications, Breast Neoplasms therapy, Female, Humans, Lymphedema etiology, Omentum blood supply, Perforator Flap blood supply, Postoperative Complications etiology, Treatment Outcome, Upper Extremity, Lymphedema surgery, Mastectomy adverse effects, Omentum transplantation, Perforator Flap transplantation, Postoperative Complications surgery
- Abstract
Background: Vascularized omental lymphatic transplant (VOLT) is an increasingly popular treatment of extremity lymphedema given its promising donor site. While the success of VOLT in the treatment of lymphedema has been reported previously, several questions remain., Aim: To further elucidate appropriate use of VOLT in the treatment of lymphedema, specifically addressing patient selection, harvest technique, and operative methods., Methods and Results: A systematic review of VOLT for upper extremity lymphedema was performed. Of 115 yield studies, seven were included for analysis based on inclusion and exclusion criteria. Included studies demonstrated significant reductions in extremity circumference/volume (average volume reduction, 22.7%-39.5%) as well as subjective improvements using patient-reported outcomes. Though studies are heterogenous and limited, when analyzed in aggregate, suggest the efficacy of VOLT in lymphedema treatment., Conclusion: This is the largest systematic review of VOLT to date. VOLT continues to show promise as a safe and efficacious surgical intervention for lymphedema in the upper extremity. Further studies are warranted to more definitively identify patients for whom this technique is appropriate as well as ideal harvest and inset technique., (© 2021 The Authors. Cancer Reports published by Wiley Periodicals LLC.)
- Published
- 2021
- Full Text
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15. The Application of an Omentum Graft or Flap in Spinal Cord Injury.
- Author
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Fay LY, Lin YR, Liou DY, Chiu CW, Yeh MY, Huang WC, Wu JC, Tsai MJ, and Cheng H
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- Animals, Neuroprotection, Rats, Spinal Cord physiology, Spinal Cord Injuries physiopathology, Surgical Flaps blood supply, Transplantation, Autologous, Treatment Outcome, Omentum transplantation, Recovery of Function, Spinal Cord surgery, Spinal Cord Injuries surgery, Spinal Cord Regeneration, Surgical Flaps transplantation
- Abstract
Background: Spinal cord injury (SCI) causes a primary injury at the lesion site and triggers a secondary injury and prolonged inflammation. There has been no definitive treatment till now. Promoting angiogenesis is one of the most important strategies for functional recovery after SCI. The omentum, abundant in blood and lymph vessels, possesses the potent ability of tissue regeneration., Methods: The present work examines the efficacy of autologous omentum, either as a flap (with vascular connection intact) or graft (severed vascular connection), on spinal nerve regeneration. After contusive SCI in rats, a thin sheath of omentum was grafted to the injured spinal cord., Results: Omental graft improved behavior scores significantly from the 3rd to 6th week after injury (6th week, 5.5 ± 0.5 vs. 8.6 ± 1.3, p < 0.05). Furthermore, the reduction in cavity and the preservation of class III β-tubulin-positive nerve fibers in the injury area was noted. Next, the free omental flap was transposed to a completely transected SCI in rats through a pre-implanted tunnel. The flap remained vascularized and survived well several weeks after the operation. At 16 weeks post-treatment, SCI rats with omentum flap treatment displayed the preservation of significantly more nerve fibers ( p < 0.05) and a reduced injured cavity, though locomotor scores were similar., Conclusions: Taken together, the findings of this study indicate that treatment with an omental graft or transposition of an omental flap on an injured spinal cord has a positive effect on nerve protection and tissue preservation in SCI rats. The current data highlight the importance of omentum in clinical applications.
- Published
- 2021
- Full Text
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16. Intrathoracic transposition of the omentum.
- Author
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Guerrero C, Berthet JP, and Gómez-Caro A
- Subjects
- Adult, Ascomycota, Female, Humans, Pneumonectomy, Lung Diseases, Fungal surgery, Omentum transplantation
- Abstract
Complex chest and lung infections with bronchial fistula are life-threatening situations with a mortality rate of up to 20%. If medical treatment fails, these patients require aggressive procedures to heal. Transposition of the omentum is a valuable, nonstandard option in these complex cases with aggressive infection involving the pleural space, with or without a bronchial fistula, when medical treatment is unsuccessful. We present a 29-year-old female patient diagnosed with primary immunodeficiency and invasive fungal infection with involvement of the left upper lobe and mediastinal and vertebral bodies treated with a lobectomy and intrathoracic transposition of the omentum., (© The Author 2021. Published by MMCTS on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
- Published
- 2021
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17. Omental patch versus gastric resection for perforated gastric ulcer: Systematic review and meta-analysis for an unresolved debate.
- Author
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Zhu C, Badach J, Lin A, Mathur N, McHugh S, Saracco B, Adams A, Gaughan J, Atabek U, Spitz FR, and Hong YK
- Subjects
- Humans, Gastrectomy methods, Omentum transplantation, Peptic Ulcer Perforation surgery, Stomach Ulcer surgery
- Abstract
Background: Perforated gastric ulcers are surgical emergencies with paucity of data on the preferred treatment modality of resection versus omental patch. We aim to compare outcomes with ulcer repair and gastric resection surgeries in perforated gastric ulcers after systematic review of literature., Methods: A systematic literature search was performed for publications in PubMed Medline, Embase, and Cochrane Central Register of Controlled Trials. We included all studies which compared ulcer repair vesus gastric resection surgeries for perforated gastric ulcers. We excluded studies which did not separate outcomes gastric and duodenal ulcer perforations., Results: The search included nine single-institution retrospective reviews comparing ulcer repair (449 patients) versus gastric resection surgeries (212 patients). Meta-analysis was restricted to perforated gastric ulcers and excluded perforated duodenal ulcers. The majority of these studies did not control for baseline characteristics, and surgical strategies were often chosen in a non-randomized manner. All of the studies included were at high risk of bias. The overall odds ratio of mortality in ulcer repair surgery compared to gastric resection surgery was 1.79, with 95% CI 0.72 to 4.43 and p-value 0.209., Conclusion: In this meta-analysis, there was no difference in mortality between the two surgical groups. The overall equivalence of clinical outcomes suggests that gastric resection is a potentially viable alternative to ulcer repair surgery and should not be considered a secondary strategy. We would recommend a multicenter randomized control trial to evaluate the surgical approach that yields superior outcomes., Level of Evidence: Systematic review and meta-analysis, level III., Competing Interests: Declaration of competing interest No disclosures to report., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2021
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18. Induced organoids derived from patients with ulcerative colitis recapitulate colitic reactivity.
- Author
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Sarvestani SK, Signs S, Hu B, Yeu Y, Feng H, Ni Y, Hill DR, Fisher RC, Ferrandon S, DeHaan RK, Stiene J, Cruise M, Hwang TH, Shen X, Spence JR, and Huang EH
- Subjects
- Adherens Junctions metabolism, Cadherins metabolism, Disease Progression, Epithelium pathology, Fibroblasts pathology, Humans, Inflammation pathology, Omentum transplantation, Phenotype, Principal Component Analysis, Sequence Analysis, RNA, Sulfonamides pharmacology, Transcriptome genetics, beta Catenin metabolism, Colitis, Ulcerative pathology, Organoids pathology
- Abstract
The pathogenesis of ulcerative colitis (UC), a major type of inflammatory bowel disease, remains unknown. No model exists that adequately recapitulates the complexity of clinical UC. Here, we take advantage of induced pluripotent stem cells (iPSCs) to develop an induced human UC-derived organoid (iHUCO) model and compared it with the induced human normal organoid model (iHNO). Notably, iHUCOs recapitulated histological and functional features of primary colitic tissues, including the absence of acidic mucus secretion and aberrant adherens junctions in the epithelial barrier both in vitro and in vivo. We demonstrate that the CXCL8/CXCR1 axis was overexpressed in iHUCO but not in iHNO. As proof-of-principle, we show that inhibition of CXCL8 receptor by the small-molecule non-competitive inhibitor repertaxin attenuated the progression of UC phenotypes in vitro and in vivo. This patient-derived organoid model, containing both epithelial and stromal compartments, will generate new insights into the underlying pathogenesis of UC while offering opportunities to tailor interventions to the individual patient.
- Published
- 2021
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19. [Multi-component multi-stage treatment of a patient with infection of thoracic aorta prosthesis, deep sternal wound infection and soft tissue deficit of the chest].
- Author
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Charchyan ER, Adamyan RT, Bedzhanyan AL, Petrosyan KA, Breshenkov DG, and Petrosyan AO
- Subjects
- Blood Vessel Prosthesis adverse effects, Humans, Omentum transplantation, Reoperation, Sternum surgery, Surgical Flaps, Thoracic Wall surgery, Treatment Outcome, Aorta, Thoracic surgery, Blood Vessel Prosthesis Implantation adverse effects, Prosthesis-Related Infections etiology, Prosthesis-Related Infections surgery, Soft Tissue Infections surgery, Surgical Wound Infection diagnosis, Surgical Wound Infection etiology, Surgical Wound Infection surgery
- Abstract
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.
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- 2021
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20. [Treatment of recurrent traumatic sternomediastinitis after cardiac surgery].
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Belov YV, Kosenkov AN, Vinokurov IA, and Al-Yousef A
- Subjects
- Fracture Fixation, Internal adverse effects, Fracture Fixation, Internal instrumentation, Humans, Mediastinitis etiology, Mediastinitis prevention & control, Postoperative Hemorrhage etiology, Postoperative Hemorrhage prevention & control, Recurrence, Therapeutic Irrigation, Cardiac Surgical Procedures adverse effects, Fracture Fixation, Internal methods, Mediastinitis surgery, Omentum surgery, Omentum transplantation, Sternum surgery, Wound Healing
- Abstract
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.
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- 2021
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21. In-vivo regeneration of bladder muscular wall with whole decellularized bladder matrix: A novel hourglass technique for duplication of bladder volume in rabbit model.
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Sabetkish S, Sabetkish N, and Kajbafzadeh AM
- Subjects
- Anastomosis, Surgical, Animals, Extracellular Matrix transplantation, Omentum transplantation, Rabbits, Serous Membrane transplantation, Urinary Bladder transplantation, Urothelium, Muscle, Smooth anatomy & histology, Regeneration, Tissue Engineering methods, Tissue Scaffolds, Urinary Bladder cytology, Urinary Bladder surgery
- Abstract
Objective: To determine histological aspects of decellularized bladder graft to achieve a double-sized bladder by novel hourglass technique; using rabbit models., Methods: Sixteen rabbit bladders were decellularized and underwent laboratory investigations. After making a laparotomy incision and exposure of bladders in another 16 rabbits (partial detrusor myomectomy), they were separated into two groups. The fundus of the decellularized scaffold was anastomosed to the fundus of the native bladder via the serosal layer, and the omentum and a double-J stent were placed in the decellularized bladder by no direct contact with the urine (Group A, n=8). In group B (n=8), the bladder was augmented applying the decellularized bladder that was in contact with the urine. After 6 months, the omentum was brought out of the neck of the engineered bladder and the anastomosis was opened. Biopsies were taken at 1, 3, and 9 months postoperatively., Results: Cell removal with preservation of extracellular matrix structure was confirmed in decellularized bladders. Histological examination after 1 month demonstrated few cells at the border of the grafts. After 3 months, the region of the graft was indistinguishable from the natural bladder with continuity of transitional epithelium of natural bladder on the decellularized grafted scaffolds. The organization of muscle layers was similar to native bladder muscle layers after 9 months. IHC staining markers were highly expressed after 9 months. Interestingly, bladders had a high fibrosis grade in group B compared with hourglass technique., Conclusion: We confirmed that decellularized bladder may be a reliable scaffold and viable material for bladder augmentation., (Copyright © 2019 Elsevier Inc. All rights reserved.)
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- 2020
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22. Successful treatment of thoracic aortic graft infection by omental flap following vacuum-assisted closure therapy.
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Türköz R, Doğan A, Türkekul Y, and Özker E
- Subjects
- Aged, Female, Humans, Treatment Outcome, Aortic Dissection surgery, Aorta, Thoracic surgery, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis Implantation adverse effects, Blood Vessel Prosthesis Implantation methods, Negative-Pressure Wound Therapy methods, Omentum transplantation, Prosthesis-Related Infections etiology, Prosthesis-Related Infections surgery, Surgical Flaps
- Abstract
Background: Postoperative thoracic aortic graft infection (TAGI) is a serious and potentially fatal complication. The classical approach is to replace the infected graft. However, this approach has a high mortality rate. Alternatively, treatment of TAGI without graft replacement can be performed METHOD: Herein, we present a 72-year-old case with mediastinitis and graft infection after type A aortic dissection operation and successful treatment using omental flap coverage following vacuum-assisted wound closure therapy without graft replacement., Conclusion: The patient had an uneventful postoperative course and remains infection-free to date., (© 2020 Wiley Periodicals LLC.)
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- 2020
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23. Technical details for harvesting gastro-epiploic lymph node flaps via mini-laparotomy incision.
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Kaya B, Ciudad P, Chen SH, Para L, and Chen HC
- Subjects
- Aged, Blood Loss, Surgical, Female, Gastroepiploic Artery surgery, Humans, Laparotomy methods, Length of Stay statistics & numerical data, Lymphedema surgery, Middle Aged, Omentum transplantation, Free Tissue Flaps, Lymph Nodes transplantation
- Abstract
Laparoscopic harvest method to obtain gastro-epiploic lymph node flaps for lymphedema treatment has been previously described. In this article, the technical details of an alternative method - open approach via mini-laparotomy incision - for harvesting gastro-epiploic lymph node flaps and preparation of the flaps for the inset is presented. A total of 17 patients were included in this series of the mini-laparotomy approach. Blood loss was minimal during the surgery. The average duration of lymph node flap harvest was 65 min. The average length of hospital stay was 10 days. The period of the restricted diet was 1.5 days. The upper abdominal scar was acceptable, there were no postoperative hernia or bulging, and there were no complications related to bowel obstruction during the follow-up. The open approach harvest method via mini-laparotomy incision offers similar results to laparoscopic harvest method, and it is safe when applied with the right technique., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2020. Published by Elsevier Ltd.)
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- 2020
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24. An Unusual Case of Intermittent Cardiac Tamponade.
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Ramponi F, Carelli MG, Ang N, Win KTH, Shah P, Palamuthusingam P, and Yadav S
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- Cardiac Tamponade surgery, Echocardiography, Humans, Male, Middle Aged, Tomography, X-Ray Computed, Cardiac Surgical Procedures methods, Cardiac Tamponade diagnosis, Heart Ventricles diagnostic imaging, Omentum transplantation, Surgical Flaps
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- 2020
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25. Use of Omental Flap for Treating Cardiocutaneous Fistula After Ventricular Aneurysm Repair.
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Ali M, Pham AN, Martinez JM, and Pham SM
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- Cardiac Surgical Procedures methods, Heart Aneurysm surgery, Heart Ventricles, Humans, Male, Middle Aged, Omentum transplantation, Cutaneous Fistula surgery, Fistula surgery, Heart Diseases surgery, Postoperative Complications surgery, Surgical Flaps
- Abstract
Infection of an endoventricular patch used for left ventricular aneurysm repair with formation of cardiocutaneous fistula is a rare but potentially serious complication. We report an adult patient who developed a cardiocutaneous fistula 1 year after repair of a third left ventricular aneurysm. The patient was successfully treated with a redo operation using a bovine pericardial patch with omental flap coverage. He is alive and well 10 years later., (Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2020
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26. The pitfall of gastric perforation by temporary pacemaker wires.
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Koechlin L, Schneider R, Fourie L, Drews S, Eckstein FS, and Reuthebuch O
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- Aged, Device Removal, Humans, Male, Omentum transplantation, Stomach Rupture diagnostic imaging, Stomach Rupture surgery, Suture Techniques, Cardiac Pacing, Artificial adverse effects, Pacemaker, Artificial, Stomach Rupture etiology
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- 2020
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27. Omental Flap Coverage for Management of Thoracic Aortic Graft Infection.
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Hernandez JA, Stranix JT, Piwnica-Worms W, Azoury SC, Kozak GM, Grimm JC, Vallabhajosyula P, Fischer JP, and Kovach SJ
- Subjects
- Aorta, Thoracic surgery, Female, Humans, Incidence, Male, Middle Aged, Reoperation, Retrospective Studies, Survival Rate trends, United States epidemiology, Blood Vessel Prosthesis adverse effects, Omentum transplantation, Postoperative Complications epidemiology, Prosthesis-Related Infections surgery, Plastic Surgery Procedures methods, Surgical Flaps, Vascular Surgical Procedures methods
- Abstract
Background: Since the first reported use of prosthetic aortic grafts, infection has remained a feared complication. Pedicled omentum is the preferred flap in managing thoracic aortic graft infection (TAGI); however the literature is sparse. The authors present their experience with TAGI managed with pedicled omental flaps., Methods: A single-institutional review from 2007 to 2018 was performed to analyze postoperative outcomes of omental flap reconstruction, performed by 2 surgeons, after a confirmed diagnosis of TAGI. The primary outcomes of overall complication rate, 30-day mortality, and in-hospital mortality were evaluated with univariate analysis., Results: Twenty patients requiring omental flap reconstruction after TAGI met inclusion criteria. The patient cohort included 14 men and 6 women with a mean age of 60.6 ± 12.9 years and a mean Charlson comorbidity index of 3.3 ± 2.1. Nine patients (45%) received omental flap reconstruction at the time of incipient TAGI surgical management by the cardiothoracic surgery team, whereas 11 patients received delayed reconstruction (mean, 6.22 days [range, 1-27]). The most common complications were graft leak (20%) and pseudoaneurysm (25%), with only 1 patient developing recurrent infection. Overall 30-day mortality was 20%. Chronic obstructive pulmonary disease and delayed omental flap reconstruction were associated with 30-day mortality (P = .04). Four of 11 patients (36.4%) who received delayed omental flap reconstruction died within 30 days, whereas 0 of 9 patients (0%) in the immediate omental coverage group died within 30 days (P = .043)., Conclusions: High mortality rates associated with TAGI exemplify the challenges associated with this disease process and patient population. Pedicled omentum is a safe adjunct with promising results to the management of TAGI while significantly reducing the risk of reinfection., (Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
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28. Omental flap for treatment of spondylodiscitis with lumbosacral dehiscence: A case report.
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Hanan L, Lonjon G, Lellouch AG, Haddad K, Arago E, Hivelin M, and Lantieri L
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- Adult, Discitis complications, Humans, Lumbar Vertebrae, Lumbosacral Region, Male, Pressure Ulcer etiology, Plastic Surgery Procedures methods, Free Tissue Flaps, Omentum transplantation, Pressure Ulcer surgery, Sacrum
- Abstract
We report a case of pedicled omental flap use together with osteosynthesis treatment of a chronic L4-L5 spondylodiscitis due to a large sacral eschar. The 43-years-old patient was paraplegic and had depleted regional flaps solutions due to multiple previous surgeries. The procedure was carried out in supine position then in prone position whereby the dissected flap was recovered through the spine. The surgery was performed by a multidisciplinary team. First, we used an anterior approach for spine osteosynthesis with a metal implant and flap harvest. Then, in a prone position, we completed the vertebral reconstruction by an L3 athrodesis to the pelvis. The flap was recovered through the spine defect, on the side of the implant. It was a right sided pedicled. Complete wound healing was 120 days. The omental flap proved to be a reliable solution in the absence of recipient vessels for free flap transfer and depleted regional flap solutions. It also spared the latissimus dorsi muscle required for a wheelchair user as in our case. The omental flap is still performed in spine surgery especially in oncologic context to prevent wound dehiscence and for spondylodiscitis coverage. The anterior approach allows for both spine osteosynthesis and flap dissection., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)
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- 2020
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29. Total surgical repair for secondary aortoesophageal fistula: two case reports.
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Ito T, Nobuoka T, Sato H, Ookawa A, Numaguchi R, Yasuda N, Arihara A, Yanase Y, Doi H, and Kawaharada N
- Subjects
- Aged, Aged, 80 and over, Aortic Aneurysm, Thoracic surgery, Esophageal Fistula complications, Esophagectomy, Humans, Male, Omentum transplantation, Thoracotomy, Aorta, Thoracic surgery, Aortic Diseases surgery, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation, Esophageal Fistula surgery, Vascular Fistula surgery
- Abstract
We present two consecutive patients with secondary aortoesophageal fistula (AEF) who successfully underwent total repair including partial esophagectomy, removal of infected vascular prosthesis, graft replacement, and esophageal reconstruction using gastric tube concomitant to omental wrapping for staged operation in short phase. One 81-year-old male who had undergone thoracic endovascular aortic repair and another 69-year-old male who had undergone graft replacement of the descending thoracic aorta were referred to our hospital for treatment of AEF. In the first operation, partial esophagectomy, removal of infected vascular prosthesis, and graft replacement were performed via left rib-cross thoracotomy. About half a day after the operation when the patients became hemodynamically stable, esophageal reconstruction was started. The gastric tube was prepared via median laparotomy and introduced to the left thoracic cavity with the omentum through the enlarged hiatus. Thereafter, the gastric tube was anastomosed to the oral side of the esophageal stump via left thoracotomy with the same wound similar to the first operation. Finally, the graft positioned parallel to the gastric tube was completely wrapped by the omentum. Both patients could ingest orally 4 weeks after surgery and maintained no recurrence of infection.
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- 2020
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30. Dural Reconstruction Using Laparoscopic Gastro-omental Free Flap in Refractory Cranial Infections.
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Elfeki B, Chang LS, Kang BK, and Eun S
- Subjects
- Adult, Aged, Brain Abscess etiology, Child, Empyema, Subdural etiology, Female, Humans, Male, Middle Aged, Postoperative Complications etiology, Recurrence, Surgical Wound Infection etiology, Brain Abscess surgery, Craniotomy adverse effects, Empyema, Subdural surgery, Free Tissue Flaps, Laparoscopy, Omentum transplantation, Postoperative Complications surgery, Surgical Wound Infection surgery
- Abstract
Background: Epidural abscesses and subdural empyema after craniotomy are potentially lethal complications in neurosurgery. Patients with recalcitrant cranial wound infections may be difficult to manage, and dural reconstruction in these patients is challenging., Methods: A total of 14 patients presented with recurrent intracranial infection after craniotomy. The symptoms and signs included persistent fever, despite prolonged systemic broad-spectrum antibiotic administration and repetitive debridement of the dural space. They underwent reconstruction with an omental free flap to cover the craniotomy defect. Microvascular anastomosis is usually performed between the gastroepiploic and superficial temporal vessels. Surgeries were performed in the chronic stages of infection, and the patients were reviewed and assessed for recurrence over the long-term postoperatively., Results: The postoperative course was uneventful, and flap survival was excellent in all patients. The patients were discharged with no evidence of wound discharge, and there were no reports of infection recurrence, flap failure, or donor site morbidity., Conclusions: The use of vascularized free omentum flap was effective in cases involving intractable cranial wound infection.
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- 2020
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31. Free gastroepiploic lymph nodes and omentum flap for treatment of lower limb ulcers in severe lymphedema: Killing two birds with one stone.
- Author
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Di Taranto G, Chen SH, Elia R, Bolletta A, Amorosi V, Sitpahul N, Chan JC, Ribuffo D, and Chen HC
- Subjects
- Aged, Chronic Disease, Female, Free Tissue Flaps surgery, Humans, Leg Ulcer complications, Lymph Nodes surgery, Lymphedema complications, Male, Middle Aged, Free Tissue Flaps transplantation, Leg Ulcer surgery, Lymph Nodes transplantation, Lymphedema surgery, Omentum transplantation
- Abstract
Background and Objectives: In patients with lymphedema, the disruption of the lymphatic network increases skin turgor and fibrosis of subcutaneous tissue, delays wound healing, causing recurrent ulcerations and infections. In these cases, management of ulcers can be challenging., Methods: Between January 2016 and June 2018, patients presenting with lymphedema were enrolled at our Institution. We selected patients with severe lymphedema and ulcers of lower limbs and we performed a surgical approach, involving free gastroepiploic lymph nodes and omentum flap, harvested through laparoscopy., Results: We enrolled 135 patients presenting for lymphedema. Among them, 10 eligible cases underwent excision of the ulcer and reconstruction with omentum flap. Mean age was 57.8 years and average follow-up 24.1 months. Circumferences and skin tonicity significantly decreased from the preoperative period. Lymphoscintigraphy showed improvement of the lymphatic drainage and restoration of lymphatic network. No episodes of infection were recorded in the postoperative period., Conclusions: Our combined procedure merges free flap techniques and lymphedema surgery: omentum covers the defect while providing a new source of lymph nodes, improving the lymphatic networks of the affected limb. This technique can highly increase the quality of life of the patient in a single-stage operation with fast recovery and low donor site morbidity., (© 2019 Wiley Periodicals, Inc.)
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- 2020
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32. Laparoscopic omental patch for perforated peptic ulcer disease reduces length of stay and complications, compared to open surgery: A SWSC multicenter study.
- Author
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Alhaj Saleh A, Esquivel EC, Lung JT, Eaton BC, Bruns BR, Barmparas G, Margulies DR, Raines A, Bryant C, Crane CE, Scherer EP, Schroeppel TJ, Moskowitz E, Regner J, Frazee R, Campion EM, Bartley M, Mortus J, Ward J, Almekdash MH, and Dissanaike S
- Subjects
- Female, Humans, Male, Middle Aged, Operative Time, Postoperative Complications epidemiology, Practice Patterns, Physicians' statistics & numerical data, United States epidemiology, Laparoscopy methods, Length of Stay statistics & numerical data, Omentum transplantation, Peptic Ulcer Perforation surgery, Postoperative Complications prevention & control
- Abstract
RCTs showed benefits in Lap repair of perforated peptic ulcer (PPU). The SWSC Multi-Center Trials Group sought to evaluate whether Lap omental patch repairs compared to Open improved outcomes in PPU in general practice. Data was collected from 9 SWSC Trial Group centers. Demographics, operative time, 30-day complications, length of stay and mortality were included. 461 PATIENTS: Open in 311(67%) patients, Lap in 132(28%) with 20(5%) patients converted from Lap to Open. Groups were similar at baseline. Significant variability was found between centers in their utilization of Lap (0-67%). Complications at 30 days were lower in Lap (18.5% vs. 27.5%, p < 0.05) as was unplanned re-operation (4.7% vs 14%, p < 0.05). Lap reduced LOS (6 vs 8 days, p < 0.001). Ileus was more in Lap (42% vs 18 p < 0.001) operative time was 14 min higher in Lap(p < 0.01) and admission to OR time was 4 h higher in Lap(<0.05). No significant difference readmission or mortality. Our results suggest Lap should be considered a first-line option in suitable PPU patients requiring omental patch repair in centers that have the capacity and resources 24/7., (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Published
- 2019
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33. Pancreaticopleural fistula: a rare cause of pleural empyema.
- Author
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Vanderbruggen W, Dhooghe V, Bracke B, Hartman V, Roeyen G, Ysebaert D, Van Schil P, and Chapelle T
- Subjects
- Debridement, Empyema, Pleural diagnostic imaging, Empyema, Pleural etiology, Humans, Male, Middle Aged, Omentum transplantation, Pancreatic Diseases complications, Pancreatic Diseases diagnostic imaging, Pancreatic Fistula diagnostic imaging, Pancreatic Fistula etiology, Recurrence, Respiratory Tract Fistula diagnostic imaging, Respiratory Tract Fistula etiology, Thoracic Surgery, Video-Assisted, Empyema, Pleural surgery, Pancreatic Diseases therapy, Pancreatic Fistula surgery, Respiratory Tract Fistula surgery
- Abstract
Aim: Pancreaticopleural fistula (PPF) is a rare complication of acute or chronic pancreatitis. When the pancreatic duct disrupts, pancreatic fluid may leak into the retroperitoneum and fistulate into the pleural cavity. Patients usually present with thoracic complaints, making it hard to suspect an abdominal etiology. Although PPF is uncommon, one must consider this diagnosis in patients with thoracic complaints and a history of alcohol abuse or pancreatitis. Methods: We present an illustrative case and review of the literature on PPF. Results: A 47-year old man was presented with recurrent PPF due to pancreas divisum, pancreatic stones and chronic exudative pancreatitis, resulting in unilateral empyema. After initial conservative treatment, operative measures were needed. We report omentoplasty against the diaphragmatic hiatus in combination with VATS (video-assisted thoracoscopic surgery) thoracotomy with decortication and debridement as a feasible operative option for resolving PPF. Conclusion: PPF is a rare complication of pancreatitis. The diagnosis is difficult to make and can be confirmed by thoracocentesis and proper imaging, preferably MRCP. Treatment options include conservative, endoscopic (ERCP) or surgical measures. Omentoplasty positioned against the diaphragmatic hiatus is a feasible technique for closure of PPF.
- Published
- 2019
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34. Intraventricular Transplantation of Omentum for Treatment of Hydrocephalus. An Experimental Study in Dogs
- Author
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González-Darder, J. M., Barcia-Salorio, J. L., Barberá, J., Broseta, J., Isamat, Fabian, editor, Jefferson, Antony, editor, Loew, Friedrich, editor, and Symon, Lindsay, editor
- Published
- 1988
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35. The results of the treatment of hand - Outcomes of the treatment of hand degloving injuries with greater omentum flaps.
- Author
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Żyluk A, Szlosser Z, and Puchalski P
- Subjects
- Adult, Female, Graft Survival, Humans, Male, Middle Aged, Poland, Plastic Surgery Procedures methods, Skin Transplantation methods, Treatment Outcome, Young Adult, Degloving Injuries surgery, Hand Injuries surgery, Omentum transplantation, Surgical Flaps
- Abstract
Degloving injury consists in tearing out the soft-tissue integument from skeleton of the hand, with accompanied nerves and vessels. The whole hand degloving has bad reputation and one of worst prognosis, even worse than total hand amputation. The range of possible salvage procedures in these cases is limited and their outcomes are unsatisfactory. One of the suitable methods is wrapping the skinned hand with pedicled or free greater omentum flap, retrieved from the abdominal cavity. The article reports outcomes of the treatment of 5 patients at a mean of 8 years after total degloving of their hands and coverage with omental flaps. All flaps healed uneventfully, but in none of the patients the whole length of the fingers was preserved. Division of stumps of 3 fingers was possible in one patient, two others had three-digital hands and remaining two had only separated thumb. Dexterity of injured hands was limited with a mean of score DASH questionnaire of 43 points. Quality of life as measured by SF-36 questionnaire was fair (58 and 53 points in physical and mental domain, respectively). Regardless this, all patients were satisfied with achieved outcomes and all returned to work, which was a confirmation of the effectiveness of the method used in their treatment.
- Published
- 2019
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36. The "String of Pearls" technique for increased surface area and lymphedematous fluid drainage in right gastroepiploic-vascularized lymph node transfer: A report of two cases.
- Author
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Fan KL, Black CK, Song DH, and Del Corral GA
- Subjects
- Anastomosis, Surgical, Arm blood supply, Female, Follow-Up Studies, Humans, Laparoscopy, Leg blood supply, Middle Aged, Breast Neoplasms surgery, Gastroepiploic Artery surgery, Lymph Nodes blood supply, Lymph Nodes transplantation, Lymphedema surgery, Omentum transplantation
- Abstract
We present our "String of Pearls" technique for upper and lower extremity lymphedema based off the right gastroepiploic artery. The entire laprascopically harvested omentum is placed through a longitudinal incision at the lymphedematous area, and anastomosed proximally, with additional distal venous outflow. This approach preserves the native lymphaticovenous architecture, distributes free lymphatic tissue along the axis of the extremity, and allows for scar release. The additional vein serves to restore bidirectional physiologic drainage inherent in the omentum and providing further lymphaticovenous drainage. We present two cases of upper and lower extremity lymphedema as a result of malignancy treated using this method. The first case was a result of breast cancer in a 55-year-old female with orthotopically placed omentum, and the second case a result of malignant nodular fasciitis in the distal lower extremity in a 56-year-old female with distally placed omentum. No complications occurred. At 3 months follow up, there is a 25% and 28% reduction in lower and upper extremity volume, respectively, with no recurrent cellulitis episodes. The safety and feasibility of placement of the entire omentum longitudinally with additional venous anastomosis are apparent. However, long-term studies are required., (© 2019 Wiley Periodicals, Inc.)
- Published
- 2019
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37. Omental patch for closure of a cecal perforation during endoscopic resection of a laterally spreading tumor.
- Author
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Galtieri PA, Auriemma F, Maselli R, Fugazza A, Mangiavillano B, Belletrutti PJ, and Repici A
- Subjects
- Adenoma diagnostic imaging, Aged, Cecal Neoplasms diagnostic imaging, Colectomy, Humans, Intestinal Perforation diagnostic imaging, Male, Tomography, X-Ray Computed, Adenoma surgery, Cecal Neoplasms surgery, Intestinal Perforation surgery, Omentum transplantation
- Abstract
Competing Interests: None
- Published
- 2019
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38. Robotic harvesting of the omental flap: a case report and mini-review of the use of robots in reconstructive surgery.
- Author
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Özkan Ö, Özkan Ö, Çinpolat A, Arıcı C, Bektaş G, and Can Ubur M
- Subjects
- Humans, Leg surgery, Male, Middle Aged, Omentum transplantation, Plastic Surgery Procedures methods, Robotic Surgical Procedures methods
- Abstract
This study describes the robotic harvesting of a free omental flap. The patient was a 58-year-old man who had undergone several previous operations due to osteomyelitis caused by trauma. There was a non-healing wound and purulent discharge in the distal pretibial region. The flap was harvested based on the right gastroepiploic artery using robotic facilities only. The flap was then transferred to the debrided defect in the pretibial region. Anastomoses were performed between the posterior tibial vessels and the pedicle of the flap. A split thickness skin graft was used to cover the omental flap. The operation lasted 2.5 h in total, including flap harvesting, microvascular anastomoses, inset and skin grafting. The postoperative period was uneventful and the patient was discharged on the 12th day postoperatively. The reliability of the technique is discussed in this report, together with a brief review of the use of robot surgery in reconstructive surgery in the literature.
- Published
- 2019
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39. Comparison of Outcomes in Oncoplastic Pelvic Reconstruction with VRAM versus Omental Flaps: A Large Cohort Analysis.
- Author
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Chaudhry A, Oliver JD, Vyas KS, Tran NV, Martinez-Jorge J, Larson D, Dozois E, Nelson H, and Manrique OJ
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Neoplasm Staging, Postoperative Complications, Retrospective Studies, Abdominal Neoplasms surgery, Omentum transplantation, Pelvic Floor surgery, Plastic Surgery Procedures methods, Rectal Neoplasms surgery, Rectus Abdominis transplantation, Surgical Flaps surgery
- Abstract
Background: The purpose of this study is to describe our experience and outcomes in oncoplastic pelvic reconstruction for patients who underwent either vertical rectus abdominis musculocutaneous (VRAM) or omental flap following abdominoperineal resection (APR) at a single tertiary care institution., Methods: All patients who underwent pelvic reconstruction following APR with either VRAM or omental flaps from January 1992 to January 2017 were retrospectively reviewed. Patient demographics and relevant comorbidities including chemotherapy and radiation therapy data were collected and analyzed. In addition, margin status at the time of oncologic resection was analyzed. Flap-specific data were collected for each approach. Oncologic data collected included cancer type, stage at time of APR, and rate of tumor recurrence within the flap., Results: A total of 562 patients were identified who underwent pelvic reconstruction with either VRAM or omental pedicle flaps. Of these, 274 (48.8%) underwent VRAM reconstruction and 288 (51.2%) underwent omental flap reconstruction. All margins were negative at time of cancer ablation surgery. Complications data included: seroma (VRAM = 2 [0.36%]; omentum = 32 [5.69%], p < 0.0001), wound dehiscence (VRAM = 31 [5.52%]; omentum = 17 [3.02%], p = 0.022), abscess (VRAM = 4 [0.71%]; omentum = 27 [4.8%], p < 0.0001), cellulitis (VRAM = 2 [0.36%]; omentum = 10 [1.78%], p = 0.025). Statistical comparison of tumor recurrence between these two reconstructive approaches showed a significantly higher recurrence rate in omental flaps compared with VRAM flaps ( p = 0.000127)., Conclusion: The results of this study suggest a significantly higher tumor recurrence rate in omental flap pelvic reconstruction compared with VRAM flaps. This knowledge has the potential to influence surgical planning and flap selection in pelvic reconstruction., Competing Interests: None declared., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)
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- 2019
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40. Successful omental patch closure with over-the-scope clip for delayed stomach perforation after endoscopic hemostasis for post-endoscopic submucosal dissection bleeding.
- Author
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Abe S, Yamada M, and Oda I
- Subjects
- Adenocarcinoma diagnosis, Gastroscopy, Humans, Male, Postoperative Hemorrhage etiology, Reoperation, Stomach surgery, Stomach Neoplasms diagnosis, Surgical Instruments adverse effects, Young Adult, Adenocarcinoma surgery, Endoscopic Mucosal Resection adverse effects, Hemostasis, Endoscopic adverse effects, Omentum transplantation, Postoperative Hemorrhage therapy, Stomach injuries, Stomach Neoplasms surgery
- Published
- 2019
- Full Text
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41. Incidence and Outcomes of Perforated Peptic Ulcers in Children: Analysis of the Kid's Inpatient Database and Report of Two Cases Treated by Laparoscopic Omental Patch Repair.
- Author
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Munoz Abraham AS, Osei H, Martino A, Kazmi S, Saxena S, Fitzpatrick CM, and Villalona GA
- Subjects
- Adolescent, Child, Child, Preschool, Databases, Factual, Female, Hospital Charges, Humans, Incidence, Infant, Infant, Newborn, Laparoscopy, Length of Stay, Male, Peptic Ulcer Perforation economics, Peptic Ulcer Perforation ethnology, Sex Factors, Treatment Outcome, United States epidemiology, Omentum transplantation, Peptic Ulcer Perforation epidemiology, Peptic Ulcer Perforation surgery
- Abstract
Introduction: Peptic ulcer disease (PUD) is a rare condition in children. Perforated peptic ulcer (PPU), a complication of PUD has an estimated mortality between 1.3% and 20%. We evaluate incidence and outcomes of PPU in children using an administrative database, perform a review of the literature, and report our technique for laparoscopic omental patch repair for PPU in two pediatric patients., Materials and Methods: Kids' inpatient database (KID's) was analyzed for demographics, incidence, and outcomes. Incidence for each year was calculated based on the reported pediatric population in the United States for 2000, 2003, 2006, 2009, and 2012 by the U.S. Census Bureau. Additionally, we present two PPU cases, accompanied by a comprehensive review of the literature., Results: The annual number of primary discharge diagnosis of PPU in the KID was 178 cases for 2000, 252 for 2003, 255 for 2006, 299 for 2009, and 266 for 2012. An increase trend over time was noted between 2000 and 2009; however, it was not statistically significant (0.05). PPU appears to be more common in Caucasian teenage boys. The mean length of stay was 8.02 days and with a statistically significant increase in healthcare charges ($33,187 versus $78,142, P = .002) when comparing year 2000-2012., Discussion: PPU is a rare cause of abdominal pain in children, but still a PUD complication that requires surgery. PPU should be included in the differential diagnosis in patients presenting with acute abdominal pain of uncertain etiology and pneumoperitoneum. Laparoscopy is both diagnostic and therapeutic. Laparoscopic omental patch repair is a safe and effective treatment for PPUs.
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- 2019
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42. Minimal invasive laparoscopic harvest of the greater omental flap for Fournier's gangrene scrotal reconstruction.
- Author
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Delgado R, Ciudad P, Espinoza FB, and Lopez J
- Subjects
- Adolescent, Humans, Male, Omentum transplantation, Fournier Gangrene surgery, Genital Diseases, Male surgery, Laparoscopy, Plastic Surgery Procedures methods, Scrotum surgery, Tissue and Organ Harvesting methods
- Published
- 2019
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- View/download PDF
43. Omental and deep inferior epigastric artery perforator flap coverage after heart transplantation to manage wide left ventricular assist device exposure with pocket infection.
- Author
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Inatomi Y, Kadota H, Kaku K, Sonoda H, Tanoue Y, and Shiose A
- Subjects
- Heart Failure surgery, Humans, Male, Middle Aged, Reoperation, Cardiomyopathy, Dilated surgery, Epigastric Arteries surgery, Heart Transplantation, Heart-Assist Devices adverse effects, Omentum transplantation, Perforator Flap blood supply, Prosthesis-Related Infections surgery
- Abstract
Infection is a serious potential complication after left ventricular assist device (LVAD) implantation. In general, infection of the device pocket, with device exposure, should be managed by early device removal and heart transplantation. However, because of the small number of donors in Japan, accelerating access to heart transplantation is often difficult and the LVAD can be widely exposed during the waiting period. We report our experience of successful heart transplantation in a patient with a widely exposed LVAD with pocket infection. A 48-year-old man suffered from heart failure due to idiopathic dilated cardiomyopathy. An LVAD was implanted, but postoperative infection led to blood pump exposure. Heart transplantation was performed 4 months after LVAD exposure, at which time the epigastric skin defect measured 14 × 8 cm. The skin defect could not be closed after heart transplantation, so it was covered by an omental flap with split-thickness skin grafts. 7 days postoperatively, the peritoneal suture broke and the intestinal tract prolapsed outside the body. Reintroduction of the prolapsed intestinal tract and deep inferior epigastric artery perforator (DIEP) flap coverage of the omental flap were performed. The postoperative course was uneventful. There have been no reports of the management of wide skin defects in the presence of infection when heart transplantation is performed. Omental flap placement was useful for controlling long-lasting infection. An omental flap placed in a patient with a wide epigastric skin defect should be covered by durable skin flap, such as a DIEP flap, to avoid intestinal prolapse.
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- 2018
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44. Letter To The Editor.
- Author
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Colak A, Kaya U, Ceviz M, Becit N, Sevil F, and Kocak H
- Subjects
- Humans, Mediastinitis etiology, Postoperative Complications surgery, Surgical Wound Infection etiology, Mediastinitis surgery, Omentum transplantation, Sternotomy adverse effects, Surgical Flaps, Surgical Wound Infection surgery
- Abstract
We read the letter of F. Rudman et al [Rudman 2017] about our article entitled "Utility of Omentoplasty in Mediastinitis Treatment following Sternotomy" [Colak 2016]. We thank them for their evaluations.
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- 2018
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45. Laparoscopic omental filling with intraoperative endoscopy for a perforated duodenal ulcer.
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Sakamoto Y, Iwatsuki M, Sakata K, Toyama E, Takata N, Yoshinaka I, Harada K, and Baba H
- Subjects
- Duodenal Ulcer pathology, Duodenum pathology, Follow-Up Studies, Humans, Intestinal Perforation pathology, Intraoperative Period, Length of Stay, Operative Time, Pain, Postoperative epidemiology, Pain, Postoperative prevention & control, Time Factors, Treatment Outcome, Duodenal Ulcer surgery, Endoscopy, Gastrointestinal methods, Intestinal Perforation surgery, Laparoscopy methods, Omentum transplantation
- Abstract
As a surgical treatment for a perforated duodenal ulcer, duodenal omental filling is effective. However, filling the perforation site with a sufficient amount of omentum is difficult in some situations. We herein report that we successfully filled a perforated duodenal ulcer with a sufficient amount of omentum using intraoperative endoscopy. The operation was performed with three ports, the operation time was 110 min, and the estimated blood loss was small. The postoperative course was good. No stenosis of deformity of the duodenum was observed on follow-up endoscopy. Laparoscopic surgery has a shorter operation time, shorter postoperative hospital stay, and less postoperative pain than open surgery. The combined use of intraoperative endoscopy with laparoscopic surgery is effective for a large perforation, and it can be expected to reduce the rate of conversion to open surgery. This combined procedure is considered useful as a laparoscopic omental filling operation.
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- 2018
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46. [Omental Flap for the Device Infection of the HeartMate II].
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Kobayashi K, Kitamura T, Torii S, Mishima T, Ohkubo H, Tanaka Y, Sasahara A, Fukunishi T, Ohtomo Y, Horikoshi R, Murai Y, and Miyaji K
- Subjects
- Adolescent, Adult, Cardiomyopathy, Dilated complications, Extracorporeal Membrane Oxygenation, Heart Transplantation, Heart Ventricles, Humans, Male, Mitral Valve surgery, Prosthesis Implantation methods, Prosthesis-Related Infections surgery, Shock, Cardiogenic etiology, Heart-Assist Devices, Omentum transplantation, Prosthesis-Related Infections prevention & control, Shock, Cardiogenic therapy
- Abstract
Case 1:An 18-year-old male underwent emergent left extracorporeal ventricular assist device(eVAD) implantation for a cardiogenic shock because of dilated cardiomyopathy (DCM). After listing for heart transplant, he underwent a HeartMate II implantation as bridge-to-bridge(BTB) therapy. The omental flap was simultaneously used to prevent device infection that could have been induced by the infected malgranulation around the cannulas of the eVAD. Eventually, he was discharged and waiting for transplantation. Case 2:A 30-year-old male with DCM underwent emergent eVAD implantation for left ventricular support, centrifugal veno-pulmonary artery extracorporeal membrane oxygenation (ECMO) for right ventricular and respiratory support, and mitral valve replacement. After weaning of ECMO, he was listed for a heart transplant and underwent a HeartMate II implantation as BTB therapy. However, liver dysfunction and malnutrition prolonged wound healing. Despite applying vacuum assist closure device to promote wound healing, part of the driveline and pump housing were exposed. Therefore, radical debridement and omentopexy were performed for infection control. He was discharged after complete wound healing.
- Published
- 2018
47. Sternal Reconstruction with the Omental Flap-Acute and Late Complications, Predictors of Mortality, and Quality of Life.
- Author
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Kolbenschlag J, Hörner C, Sogorski A, Goertz O, Ring A, Harati K, Lehnhardt M, and Daigeler A
- Subjects
- Adult, Aged, Aged, 80 and over, Cohort Studies, Female, Follow-Up Studies, Humans, Male, Middle Aged, Omentum surgery, Reoperation methods, Retrospective Studies, Risk Assessment, Sternotomy methods, Surgical Wound Infection mortality, Surgical Wound Infection physiopathology, Survival Rate, Treatment Outcome, Omentum transplantation, Quality of Life, Plastic Surgery Procedures methods, Sternotomy adverse effects, Surgical Flaps transplantation, Surgical Wound Infection surgery
- Abstract
Background: The omental flap is a reliable flap for the coverage of sternal defects. However, little is known about the predictors of mortality and the long-term outcome in such patients., Methods: We, therefore, performed a retrospective study from 2002 to 2013, including all patients who underwent sternal reconstruction with the omental flap., Results: A total of 50 patients were identified and mean follow-up was 3.8 years. Patient data was collected from the charts and 14 patients were available for telephone interviews. The majority of patients suffered from deep sternal wound infections. There was no complete flap loss and an overall success rate was 96%. In-hospital mortality was 14% and overall survival over follow-up was 50%. Significant predictors of mortality were age > 65, American Society of Anesthesiologists' status, defect size, prolonged ventilation, and the need for tracheotomy. Postoperative quality of life was reduced compared with other cohorts, especially with regard to bodily function. Pain was also a major problem for most patients along with herniation., Conclusion: The omental flap is a safe option even in patients with severe comorbidities. However, based on the data in this study, we would recommend the omental flap as a reserve option rather than first-line treatment for sternal defects., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)
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- 2018
- Full Text
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48. Supercharged free omental flap plombage for empyema in a patient with an artificial pericardium.
- Author
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Matsumoto I, Iino K, and Takemura H
- Subjects
- Aged, Empyema diagnosis, Empyema etiology, Humans, Male, Thymoma diagnosis, Thymoma surgery, Thymus Neoplasms diagnosis, Thymus Neoplasms surgery, Tomography, X-Ray Computed, Artificial Organs, Empyema surgery, Free Tissue Flaps, Omentum transplantation, Pericardium, Postoperative Complications, Thymectomy adverse effects
- Abstract
Cavernostomy and fenestration were performed in a patient who developed a lung abscess and empyema in the left lung, which was damaged after multimodality therapy for advanced thymoma. The hospitalized patient suddenly experienced cardiopulmonary arrest due to major bleeding from the left main pulmonary artery. We immediately performed the main pulmonary arterial embolization, and the patient was resuscitated. Subsequently, the patient underwent supercharged free omental flap plombage performed in the following manner: first, laparoscopic harvesting of the omentum was performed in the supine position. Then, the right gastroepiploic artery and vein were anastomosed with the left axillary artery and vein, respectively. The lung cavity, bleeding point of the pulmonary artery and the surface of the artificial pericardium were filled and covered by the supercharged omentum, and the skin was closed. The postoperative course was uneventful. The patient has had no bleeding, recurrence of empyema and thymoma or skin abnormalities at 36 months postoperatively. Supercharged free omental flap plombage was a useful option for treatment of an intractable chest infection involving an artificial pericardium.
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- 2018
- Full Text
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49. Double vascularized omentum lymphatic transplant (VOLT) for the treatment of lymphedema.
- Author
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Kenworthy EO, Nelson JA, Verma R, Mbabuike J, Mehrara BJ, and Dayan JH
- Subjects
- Follow-Up Studies, Free Tissue Flaps blood supply, Humans, Lymph Nodes blood supply, Minimally Invasive Surgical Procedures, Omentum blood supply, Retrospective Studies, Treatment Outcome, Free Tissue Flaps transplantation, Lymph Nodes transplantation, Lymphedema surgery, Omentum transplantation
- Abstract
Background and Objectives: Orthotopic vascularized lymph node transplant has been successfully used to treat lymphedema. A second, heterotopic lymph node transplant in the distal extremity may provide further improvement. The vascularized omentum lymphatic transplant (VOLT) provides adequate tissue for two simultaneous flap transfers to one limb. The purpose of this study was to review our experience with this technique., Methods: We conducted a retrospective study of patients who underwent VOLT, with a subgroup analysis of patients who underwent double VOLT. Technical aspects of the procedure, complications, and early outcomes were reviewed., Results: From May 2015 to August 2017, 54 VOLTs were performed in 38 patients, of whom 16 received double VOLT. Among patients in the double VOLT group with postoperative imaging at 1 year, uptake into the transplanted omentum was seen in three of six (50%) patients on lymphoscintigraphy and in one of five (20%) patients on indocyanine green lymphangiography. One patient (3.1%) in the double VOLT group required a return to the operating room. There were no donor site complications in the double VOLT group. The overall complication rate was 15.8%., Conclusions: Double VOLT to the mid-level and proximal extremity is a safe and viable option., (© 2018 Wiley Periodicals, Inc.)
- Published
- 2018
- Full Text
- View/download PDF
50. [Greater omentum flap: Treatment of chronic wounds and seroma: About a case].
- Author
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Boccara D, Serror K, Mimoun M, and Chaouat M
- Subjects
- Chronic Disease, Female, Humans, Middle Aged, Omentum transplantation, Postoperative Complications surgery, Seroma surgery, Surgical Flaps, Surgical Wound Infection surgery
- Abstract
Introduction: Cicatricial complications after abdominal or pelvic surgery are more frequent in obese patients. In this case, infection, seroma and delays in scarring can be extremely difficult to treat. The objective of this technical note is to present an original case of an obese patient operated nine years ago of a hysterectomy by laparotomy and chronically presenting a non-resolving septic seroma despite multiple surgical procedures whose healing could be obtained by a flap of greater omentum., Surgical Technique: The ideal is to carry out this intervention in a double team with a digestive surgeon in case of intra-abdominal visceral or vascular wound during dissection. The greater omentum flap was raised in a conventional manner over the gastroepiploic artery. A sufficiently wide orifice should be left at the level of the abdominal aponeurosis in order to avoid any compression of the pedicle. Finally, the flap must be spread over the whole surface of the detachment and fixed to the anterior aponeurosis., Conclusion: Reliability and vascular and lymphatic richness make the greater omentum flap a very effective method in chronic wound cases associated with important seroma. The scarring obtained in the clinical case presented thus highlights the specific qualities of this flap., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
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