PL EN


Preferences help
enabled [disable] Abstract
Number of results
2009 | 81 | 11 | 503-511
Article title

Management of Extensive or Infected Soft Tissue Defects in Upper Limb by Means of Pediculated Omental Flaps

Content
Title variants
Languages of publication
EN
Abstracts
EN
The basis for the treatment of deep tissue defects, particularly those that are infected, is coverage of the exposed anatomical structures with well vascularized tissues. To this end various kinds of vascularized-pedicled and free flaps are utilized. Post-trauma, soft tissue defects in the region of the upper extremity often involve areas of tissue poorly perfused, affected by necrosis and bacterial colonization. The size of the defect with accompanying intense purulence limits the application of local reconstruction and fasciocutaneal and muscle flaps. The greater omentum is one of the most promising and universal flaps on account of it's bactericidal and angiogenetic properties. The first report regarding a successful application of omentum in plastic surgery dates from 1965 year.The aim of the study was to present treatment results of extensive as well as infected tissue defects of upper limb with the application of pedicled omental flaps in material from Sub-Department of Limb Replantation in Trzebnica.Material and methods. Between 2005-2009 in the St. Hedwig's Hospital 35 patients (30 M, 5 F) avg age 38.3 (range 10-73) were treated using omentum flaps. The causes of defects were primarily crush injuries (13), burn wounds (2), secondary necrosis of replanted/revascularized limb tissues (14) including chronic bone infections, contaminated degloving injuries of upper limb (4). The area of tissue defect amounted to avg 84 cm2 (range 25-227 cm2)Most of this, 31/35 (89%) posed infected wounds (Staphylococcus aureus 11, Escherichia coli 12, Enterococcus faecalis 11, Staphylococcus coagulsonegative 10, Pseudomonas aeruginosa 5, Acinetobacter baumanii 6, Proteus mirabilis 6, Enterobacter cloacae 4). The procedure was based on covering of the defects with pedicled omental flap obtained during epigastric laparotomy, with split- thikness skin graft. After the procedure apart from the surgical prophylaxis general antiobtic therapy was not applied, nor locally. After 3-4 weeks the pedicle of flap was cuted and it's appearance was modeled as well as covered using skin graft.Results. Complete healing with good fuctional and cosmetic results was achieved in 32/35 cases, after transplantation of omentum in 52% of wounds a change in bacterial flora was observed to saprofitic and antibiotic-sensitive, and in 38% donor site was aseptic. Cultures were attained, in the remainder signs of infection receded despite the presence of pathological flora. In 2 cases complete or partial necrosis of flap was observed, in one the vital flap was removed due to amputation of limb (crush syndrome). Complication in the form of hernia were observed in 5/35 patients, however no complaints of abdominal pain or abscess of space drawing.Conclusions. Free and pedicled omental flaps appear to be the ideal solution in the treatment of tissue defects and bone infections chronically infected with antibiotic-resistant cultures. The omentum also is a appropriate material for covering of fresh defects with exposed ligaments, nerves and bones. The complications at the obtaining site in our material occured rarely when compared to the available published data. Currently it is possible also to harvest the omentum laparoscopically.
Publisher
Year
Volume
81
Issue
11
Pages
503-511
Physical description
Dates
published
1 - 11 - 2009
online
24 - 12 - 2009
References
  • Kobus K, Licznerski A, Stępniewski J i wsp.: Płaty skórne, mięśniowe, mięśniowo-skórne. Pol Przegl Chir 1981; 53: 543-49.
  • Kobus K, Stępniewski J: Free flaps versus conventional surgery. Ann Plast Surg 1985; 15: 14-18.
  • Shen YM, Shen ZY: Greater omentum in reconstruction of refraktory wounds. Chin J Traumatol 2003; 6(2): 81-85.[PubMed]
  • Silva PC, Jamel N, Rafinetti RA et al.: Development of blood vessels of the greater omentum in the hepatic lobe after vascular ligation. An experimental model in the rats. Acta Cir Bras 2006; 21(6): 416-21.
  • Azuma H, Kondo T, Mikami M et al.: Treatment of chronic osteomyelitis by transplantation of autogenous omentum with microvascular anastomoses. Acta Orthop Scand 1976; 47: 271-73.[Crossref]
  • Munteanu M, Pirscoveanu M, Munteanu MC et al.: The great omentum in surgical pathology. Chirurgia (Bucur) 2004; 99(5): 357-66.
  • Kiricuta I: Use of greater omentum in plastic surgery. Wyd. I. Bucaresti. Editura medicala 1980.
  • Maloney CT, Wagas D, Upton J et al.: Free omental tissue transfer for extremity coverage and revascularization. Plast Reconstr Surg 2003; 111: 1899-1904.[Crossref]
  • Goldsmith HS et al.: Lipid angiogenic factor from omentum. J AM Med Assoc 1984; 252(15): 2034-46.
  • Browne JD, Thompson JN, Gibson FB: Omental extract as an adjunct to local skin flap surviaval. Surgical Forum 1986; 37: 588-91.
  • Zieliński M: Significance and application of the greater omentum in surgery. Pol Merkur Lekarski 2002; 13(73): 86-88.
  • Cartier R, Brunette J, Hushimoto K et al.: Angiogenic factor A possibile mechanism for neovascularizationproduced by omental pedicles. J Thorac Cardiovasc Surg 1990; 99: 264-66.
  • Voy ED: Vascularization and resorption of different supporting tissues by the greater omentum in the formation of compound microvascular transplants. Handchir Microchir Plast Chir 1985; 17 Suppl.: 62-65.
  • Goitz RJ, Steichen JB: Microvascular omental transfer for the treatment of severe recurrent median neuritis of the wrist: long term follow-up. Plast Reconstr Surg 2005; 115: 163-71.
  • Prowans P, Deskur Z, Brzeziński W i wsp.: Zaopatrywanie ubytków tkanek w obrębie kończyny górnej za pomocą sieci większej. Pol Przegl Chir 1998; 70: 54-59.
  • Prowans P, Deskur Z, Żyluk A: Przeszczepy sieci większej - zastosowania i komplikacje. Chir Narz Ruchu Ortop Pol 1998; 63(6): 529-34.
  • Stock W, Lewan U, Lucas B et al.: Plastic surgery in soft tissue reconstruction in large extremity defects. Orthopade 1994; 23: 389-95.
  • Irons GB, Witzke DJ, Arnold PG et al.: Use of omental free flap for soft-tissue reconstruction Ann Plast Surg 1983; 11(6): 501-07.
  • Shilov B: Greater omental autotransplantation in plastic surgery. Plast Reconstr Surg 2004; 114: 1342-43.[Crossref][PubMed]
  • Hari K: Free omental flap transfer. Clin Plast Surg 1978; 5: 273-81.
  • Ciuce C, Seddiq F, Fodor M et al.: Omental free-tissue transfer; indications and results from personal experience. Microsurgery 2003; 23:198-20.[Crossref]
  • Arnhold PG, Witzke DJ, Irons GB et al.: Use of omental transposition flaps for soft-tissue reconstruction. Ann Plast Surg 1983; 11: 508-12.
  • Krauss M: Podstawy chirurgii plastycznej. W: Śliwiński M, Rudowski R (red.): Chirurgia kliniczna i operacyjna. PZWL, Warszawa 1983; 699-708.
  • Agca B, Paksoy M et al.: Influence of omentectomy on peritoneal mechanisms in an experimental model of intra-abdominal infection. Eur Surg Res 2003; 35(1): 35-40.[Crossref]
  • Hultman CS, Carlson GW, Losken A et al.: Utility of the omentum in the reconstruction of complex extraperitoneal wounds and defects: donor site complications in 135 patients from 1975-2000. Ann Surg 2002; 235(6): 782-95.
  • Ghazi BH, Carlson GW, Losken A: Use of the greater omentum for reconstruction of infected sternotomy wounds: a prognostic indicator. Ann Plast Surg 2008; 60(2): 169-73.[WoS]
  • Van Garderen JA, Wiggers T, Van Geel AN: Complications of the pedicled omentoplasty. Neth J Surg 1991; 43(5): 171-74.[PubMed]
  • Matsumura Y, Handa M, Shiraishi Y et al.: Abdominal complications of the pedicled omental flap in chest surgery. Nippon Geka Gakkai Zasshi 1992; 93(5): 533-39.
  • Seitz IA, Williams CS, Weidrich TA et al.: Omental Transfer for Coverage of Complex Upper Extremity and Hand Defects- the Forgotten Flap. Hand (NY) 2009; 25.[Crossref]
  • Acarturc TO, Swartz WM, Luketich J et al.: Laparoscopically harvested omental flap for chest wall and intrathoracic reconstruction. Ann Plast Surg 2004; 53: 210-16.
Document Type
Publication order reference
YADDA identifier
bwmeta1.element.-psjd-doi-10_2478_v10035-009-0082-1
Identifiers
JavaScript is turned off in your web browser. Turn it on to take full advantage of this site, then refresh the page.