Mathisen D J, Grillo H C, Vlahakes G J, Daggett W M
General Thoracic Surgical Unit, Massachusetts General Hospital, Boston 02114.
J Thorac Cardiovasc Surg. 1988 Apr;95(4):677-84.
The pedicled omentum finds use in cardiothoracic surgery for management of complicated problems and prevention of serious complications. Its blood supply is excellent and is capable of inducing neovascularity. Based on the right gastroepiploic artery, it reaches anywhere in the thorax or neck. Its bulk helps to fill infected spaces. Thirty-seven patients have been treated with the pedicled omentum. In 16 patients the goal was preventive, to avoid bleeding, anastomotic leakage, or infection or to provide a source of fibroplasia or neovascularity. In eight patients with cervical exenteration the flap protected against innominate artery erosion and esophageal leakage, generally in an irradiated field. In six patients it permitted primary healing of heavily irradiated trachea--formerly unlikely. It was also used to provide coverage of a chest wall prosthesis in two patients. In 21 patients the omentum was used to obtain healing in the presence of infection. Bronchopleural fistulas were successfully closed in eight of nine patients. Six mediastinal infections that developed after cardiac operations were successfully treated. Four unusual vascular infections necessitated the use of omentum. Two patients had closure of esophageal perforations buttressed with omentum. This series demonstrates the efficacy of the omentum in the management of complex cardiac, vascular, esophageal, tracheal, bronchial, pleural, and chest wall problems.
带蒂大网膜在心胸外科手术中用于处理复杂问题和预防严重并发症。其血供良好，能够诱导新生血管形成。基于胃网膜右动脉，它可到达胸部或颈部的任何部位。其体积有助于填充感染腔隙。37例患者接受了带蒂大网膜治疗。16例患者的目的是预防性的，以避免出血、吻合口漏或感染，或提供纤维组织增生或新生血管形成的来源。在8例进行颈部脏器廓清术的患者中，皮瓣可防止无名动脉侵蚀和食管漏，通常是在放疗区域。在6例患者中，它使曾难以实现的重度放疗后的气管得以一期愈合。它还用于为2例患者的胸壁假体提供覆盖。在21例患者中，大网膜用于在存在感染的情况下促进愈合。9例支气管胸膜瘘患者中有8例成功闭合。6例心脏手术后发生的纵隔感染得到成功治疗。4例特殊的血管感染需要使用大网膜。2例患者用大网膜加固后食管穿孔得以闭合。本系列研究证明了大网膜在处理复杂的心脏、血管、食管、气管、支气管、胸膜和胸壁问题方面的有效性。
