Use of the omental free flap for soft-tissue reconstruction.

Omentum can be useful as a free flap for soft-tissue reconstruction in a variety of difficult wounds. Omentum was successfully used as a free flap in 11 of 15 patients. Of the 15 defects, 2 were located on the scalp, 2 on the face, 2 on the thigh, and 9 on the lower leg. The failure rate of 27% (4 out of 15) was higher than the 10 to 15% failure rate that we have experienced with skin and muscle flaps. The most frequent cause of failure was the use of diseased recipient vessels for the microvascular anastomoses, that is, vessels with scar tissue, inflammation, or arteriosclerotic changes. Poor blood flow in the recipient vessel also was a harbinger of trouble. This low-flow phenomenon was more prevalent when the anterior tibial vessels of the lower leg were used. In spite of these problems, omentum is useful as a free flap for selected difficult soft-tissue defects.