Microvascular Free Transfer of Omentum

Y. IKUTA

If the scalp has been avulsed, the obvious first choice is replantation, when feasible (1). If the injury is old or results from other defects such as tumor excision or burns, other methods must be sought (2).

If the periosteum is still intact, split-thickness skin grafts can readily survive but do not provide stable coverage (3). Ulcerations are frequent, especially when the area is covered with a wig. The situation is even worse if a split-thickness skin graft is applied to a skull that has been decorticated of its outer table. Full-thickness skin grafts are more stable but do not take well, and the available donor sites are often not adequate (4).

The availability of local and distant flaps is limited. Instead, free vascularized skin, muscle, or omental flaps can be used with good results (5, 6, 7, 8).

INDICATIONS

There are several advantages to the vascularized omental flap. It can be used, in association with a skin graft, to treat large defects. It can be easily shaped to any desired size, and it can be used to improve the circulation of a suitable recipient site. It is generally used when there is an extensive tissue defect, the surface of the defect is irregular in shape or narrow and deep, the circulation is poor, or infection is present.

However, since the omental tissue must be obtained by abdominal laparotomy, consideration must be given to the fact that its original function will decrease, with the risk of causing panperitonitis (9). The possibility of employing other procedures, such as a skin flap, a musculocutaneous flap, or a muscle flap with skin graft, must be seriously considered.

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