Omental Flap for Cheek, Neck, and Intraoral Reconstruction
S. K. DAS
M. A. LESAVOY
The good vascularity, unique arrangement of blood vessels, and ability to accept skin grafts with ease allow the omentum, which is dispensable, to be an excellent salvage flap.
INDICATIONS
Typical indications for use of the omentum are (a) to protect the exposed, irradiated carotid vessels following block dissection of the neck as well as to prevent carotid blowout (1) (see Chapter 140); (b) to reconstruct the pharyngostome; (c) to reconstruct full-thickness cheek defects (2); (d) to contour the face, and (e) to use as cover for the face with the addition of split-thickness skin grafting following massive tissue loss (3, 4).
FLAP DESIGN AND DIMENSIONS
For pedicle transfer of the omentum from within the abdominal cavity to distal targets, such as the neck or face, various lengthening procedures are mandatory (5, 6, 7, 8). Following omentocololysis (6), there is a gain in omental length of 2 to 12 cm. For the omentum to reach the neck, however, omentogastrolysis (freeing of the omentum from the greater curvature of the stomach, based on a right or left gastroepiploic pedicle) is necessary. Usually, the right gastroepiploic vessels are larger than the left, and at least one other major artery should be preserved and left attached to the stomach. The gastroepiploic arch is maintained with the omentum (Fig. 191.1).
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
