Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, California, United States.
Microsurgery. 2024 Jan;44(1):e31017. doi: 10.1002/micr.31017. Epub 2023 Feb 8.
The omentum has gained recent popularity in vascularized lymph node transfers (VLNT) as well as its novel use as a free flap for autologous breast reconstruction. The omentum has multiple unique advantages. It can be harvested laparoscopically or in an open fashion when utilized with abdominally-based free flaps. Additionally, it can be split into multiple flaps for simultaneous autologous breast reconstruction with VLNT or for multiple sites of VLNT. We present the safe and advantageous use of the omentum for VLNT with simultaneous autologous breast reconstruction in a series of patients.
From the years 2019-2022, patients who underwent breast reconstruction with deep inferior epigastric artery perforator (DIEP) or muscle sparing tram (MS-TRAM) flaps with concurrent omental VLNT through a mini-laparotomy or breast reconstruction with Omental Fat-Augmented Free Flap (O-FAFF) with concurrent laparoscopic harvesting of omental VLNT were studied. Patient demographics included age, gender, comorbidities, prior radiation or chemotherapy, body mass index, complications, hospital length of stay, and surgical outcomes.
A total of seven patients underwent omental VLNT with breast reconstruction for a total of 12 breasts and eight limbs treated. Three of the patients underwent autologous breast reconstruction using omental free flap. The mean age was 52.3 (range 40-75) years and mean body mass index (BMI) was 29.3 (range 23-38) kg/m . The flap survival rate was 100%. All the patients had successful reduction of extremity circumference and improvement of symptoms. The range of follow-up was 5 to 19 months, with an average follow-up of 14.6 months. There was only one complication among our 7 patients: a patient with a BMI of 38 developed a post-surgical abdominal wound treated with local wound care. Otherwise, post-operative courses were uneventful, and no further complications were reported.
We demonstrate here additional evidence to the growing body of literature of the versatility and safety of the omentum to be utilized as an independent tool for surgical treatment of lymphedema as well as its simultaneous use with autologous breast reconstruction.
网膜在血管化淋巴结转移 (VLNT) 中以及作为自体乳房重建的游离皮瓣的新用途方面最近受到了关注。网膜具有多种独特的优势。它可以通过腹腔镜或开放性手术采集，当与腹部游离皮瓣一起使用时。此外，它可以分成多个皮瓣，用于同时进行 VLNT 自体乳房重建或多个 VLNT 部位。我们在一系列患者中展示了安全且有利的使用网膜进行 VLNT 同时进行自体乳房重建。
从 2019 年到 2022 年，对接受深下腹动脉穿支 (DIEP) 或肌保留 tram (MS-TRAM) 皮瓣乳房重建且同时进行网膜 VLNT 的患者进行了研究，这些患者通过小切口进行或使用网膜脂肪增强游离皮瓣 (O-FAFF) 进行乳房重建，同时进行腹腔镜下网膜 VLNT 采集。患者的人口统计学数据包括年龄、性别、合并症、既往放疗或化疗、体重指数、并发症、住院时间和手术结果。
共有 7 名患者接受了网膜 VLNT 联合乳房重建，共 12 个乳房和 8 个肢体接受了治疗。其中 3 名患者接受了网膜游离皮瓣的自体乳房重建。平均年龄为 52.3 岁（范围 40-75 岁），平均体重指数 (BMI) 为 29.3（范围 23-38）kg/m 。皮瓣存活率为 100%。所有患者均成功减少了肢体周长并改善了症状。随访时间为 5 至 19 个月，平均随访时间为 14.6 个月。我们 7 名患者中只有 1 名发生并发症：1 名 BMI 为 38 的患者发生术后腹部伤口，经局部伤口护理治疗。否则，术后过程平稳，无进一步并发症报告。
我们在这里证明了更多证据，证明网膜作为治疗淋巴水肿的独立工具以及与自体乳房重建同时使用的多功能性和安全性不断增加。
