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136 136 Source ofSupport: Paper Received: Review Article exceptional versatility exceptional versatility The omentum:Auniqueorganof The omentum:Auniqueorganof functions, theomentumis oftenforgotten. 20 as “ surgeon RutherfordMorrisontorightlynameit area, afunctionthathasmadetheBritish concerned siteandsealingitfromthenearby of intraperitonealinfectionsbymovingtothe of macrophages.Itisalsosaidtolimitthespread “milky spots,”whicharenothingbutcollections peritoneal cavityfrominfectionsbyvirtueofits serving asastorehouseoffat,itprotectsthe varying amountoffatdeposition.Apartfrom appears asathinfenestratedmembranewith variable extentovertheintestinalloops.It curvature ofthestomachlikeanaprontoa of peritoneumthathangsdownfromthegreater The greateromentumisnothingbutalargefold 2006;68:136-41. Alagumuthu M,DasBB,PattanayakSP,RasanandaM.Theomentum:Auniqueorganofexceptionalversatility.IndianJSurg How tocitethisarticle: ABSTRACT Siba P.Pattanayak,BanchanidhiNagar,Khodasingi,Berhampur-760010,India.E-mail:[email protected] For correspondence: Department ofGeneralSurgery,M.K.C.GMedicalCollegeHospital,Berhampur,Orissa,India M. exceptional versatility The omentum:Auniqueorganof exceptional versatility exceptional versatility The omentum:Auniqueorganof The omentum:Auniqueorganof th Alagumuthu,BhupatiB.Das,SibaP.Pattanayak,MangualRasananda The policemanoftheabdomen century K omentum wasplacedintheabdomenforareason. versatility from thosepublicationsaremethodicallysummarized.Theomentumisindeedanorganofexceptional publications. Allthosepublicationsweresystematicallyreviewedandanalyzed.Theinferencesderived keywords “omentum,omentoplastyandsurgicalusesofomentum.”Thesearchrevealedabout86 extensive searchwascarriedoutontheinternetforindexedpublicationsinEnglishliteratureusing account ofthevarietyapplicationsomentuminvariousdisciplinessurgicalpractice.An tissue withimmensetherapeuticpotential.W and scientistsallovertheworld,whichhaveproventhatomentumisaunique,physiologicallydynamic since thebeginningoflastcentury In thepast,omentumwasconsideredtobeaninerttissuewithoutmuchbiologicalsignificance.But ey words: May, 2006. Nil. . Inspiteofallthesevaluable . Thisreviewpresentedbyuswillenablethereaderstoappreciatefactthat,clearly Conflict ofInterest: Omentoplasty Paper Accepted: , omentum,surgicalusesofomentum None declared. June, 2006. ” intheearly , innumerablestudiesandtrialshavebeenconductedbysurgeons e haveundertakenthepresentreviewtoprovideaconcise and extra-abdominal procedures.Thearterial andvenous microvascular techniques for variousintra-abdominal vascular pedicle,exteriorized ordetachedusing that itcanbelengthenedto anunbelievableextentata arrangement ofthevascular arcadesareinsuchaway Anatomically material againstinflammation andirradiation. a varietyofcelltypes.Itprovidesanexcellentplastic contains omnipotentstemcellsthatcandifferentiateinto neurotrophic factorsandinflammatorymediators,also source ofvariousgrowthfactors,neurotransmitters, revealed thattheomentum,apartfrombeingagreat wastes andtoxicsubstances.Recentstudieshave enormous amountsofedemafluidsandremovemetabolic potent lymphaticsystemoftheomentumcanabsorb vessels intowhatevertissueitisplacedcloseto.The of angiogenicfactorsthatpromotethegrowthblood Basically innumerable applicationsinday-to-daysurgicalpractice. Certain specialattributesoftheomentumfavorits SPECIAL PROPER , itisahighlyvascularor Indian J Surg|June2006 |Volume68 |Issue3 , theattachmentsofomentum andthe TIES OFTHEOMENTUM gan witharichsource The omentum supply to the omentum are derived from the branches severity of leakage. Omentoplasty and possible drainage of the right and left gastroepiploic vessels that course may be considered in rare prohibitive cases of colonic along the greater curvature of the . Division of diverticular disease with adhesions and conditions that the right or left gastroepiploic and the vasa recta prevent effective segmental resection, peritoneal lavage along the greater curvature of the stomach with and proximal fecal diversion. In majority of patients mobilization of the omentum from the transverse colon undergoing abdominoperineal resection for allows the development of a vascularized omental adenocarcinoma of lower , sutured perineal pedicle flap. The following is an account of the various omentoplasty merits consideration and is associated ways by which the omentum can be put into use in the with excellent primary perineal wound healing.[8] modern surgical field. Vascularized omental pedicle flap can be used to prevent the from entering the pelvis after GASTROINTESTINAL abdominoperineal resection, thus preventing radiation enteritis during radiation therapy for rectal carcinoma. The most common use of omentum is as an adjunct to A new procedure has been devised for abdominal intestinal surgery, wherein it is often wrapped around rectopexy, wherein the omentum can be used to support the sites of anastomosis. The omentum fills in small the rectum below the rectopexy, to reconstruct the gaps between the sutures and provides a good source of anorectal angle and to avoid the need for synthetic blood vessels and inflammatory cells for healing. meshes.[9] The omentum’s rich vascularity and high Anastomotic leakage is the most feared complication in content of thromboplastin is an excellent feature for the surgery of cancer of cardia and . The treating difficult-to-handle abdominal or pelvic abscesses incidence of leakage is more common in cervical and for inducing hemostasis. anastomoses, while it is virtually fatal when it occurs in intrathoracic anastomoses. Due to its capacity of NEUROSURGERY localizing infection and sealing microperforations, most authors strongly recommend omentoplasty in every case The omentum finds its application in the field of of radical surgery for cancer of cardia and esophagus.[1] neurosurgery due to the fact that it is the best tissue to For the management of perforated gastric ulcer, omental provoke revascularization and through these vessels the patch closure and ulcer excision are as effective as underlying and adjacent brain receives increased blood .[2] For perforated duodenal ulcers, the flow, oxygen, omental neurotransmitters (dopamine, Graham omental patch closure is a well known and noradrenaline and acetylcholine) and neurotrophic commonly performed procedure. Cellan-Jones omental factors (nerve growth factor and gangliosides).[10] The patch is a simple, timesaving and dependable procedure conventional surgical procedures for epilepsy include even for closure of large duodenal perforations up to 3 surgical ablation of the epileptogenic zone, disconnection cm in size. The omental plug can be reliably used for procedures and vagus nerve stimulation. Placing the occluding large duodenal defects, wherein it promotes omental tissue directly upon the epileptic focus (medial healing through a combined process of inflammation, temporal lobe structures) and neighboring areas (posterior granulation, vascularization and fibrosis, eventually hypothalamus, subcommisural region and extreme providing a normal duodenal mucosal cover to the superior of mesencephalic reticular nucleus) can reduce perforation site.[3] During , or abort complex partial seizures.[11] Hypoperfusion and wrapping an omental flap around the dissected hypometabolism of the epileptic foci are normalized and splanchnic vessels reduces postoperative intra- neuronal hyperexcitability is reduced. Omental abdominal bleeding and infection.[4] Surgery is the transplantation on the optic chiasma, carotid bifurcation cornerstone in the management of echinococcosis. and the anterior perforated substance can improve the Omentoplasty of the hydatid cyst cavity, if feasible, is symptoms of Alzheimer’s disease.[12] Application of preferred to tube drainage.[5] Omentoplasty of the abscess vascularized omental graft has been shown to benefit cavity can be useful for patients with both complicated patients with ischemic cerebrovascular diseases.[13] and noncomplicated amebic abscesses. This Intracranial transplantation of omentum can help patients procedure may be used for managing liver abscess with cerebrovascular moyamoya disease. Cerebrospinal complicating perforative colonic diverticulum.[6] Arrest fluid fistulas are a major source of morbidity after of severe liver hemorrhage in victims of blunt injury pericranial . Free microvascularized omental abdomen by tamponade with a viable omental pack is flap can be used in an intracranial position for the an almost uniformly successful technique. In pediatric management of chronic CSF rhinorrhea.[14] Similarly, splenic trauma, omentoplasty can be combined with pedicled or free omental graft can be transposed to the splenorrhaphy or partial splenectomy as a valuable lumbar subarachnoid space to resorb CSF. Though there spleen-saving procedure. The omental lipid fraction has are only a few published reports with detailed outcomes, been shown to contain a factor that induces good numerous claims are being made in favor of omental regeneration of splenic transplants.[7] In colorectal transposition in chronic spinal cord injury.[15] However, anastomosis also, omentoplasty appears to contain the this procedure may have a definite role in the

Indian J Surg | June 2006 | Volume 68 | Issue 3 137 Alagumuthu M, et al. management of acute spinal cord injury as an adjunct published series have shown marked improvement of to neural grafting and reconstruction using collagen intermittent claudication and rest pain, healing of bridges and neurotrophic factors.[16] ischemic ulcers and delaying of progression of gangrene.[23] Patients with buerger’s disease of the upper CARDIOTHORACIC SURGERY extremities can also be benefited by omentopexy. Pedicled omentum, prepared through midline , can The omentum, apart from being a well vascularized be placed through a subcostal incision to the tissue, is also a good source of angiogenic factors like subcutaneous space of the forearm and the affected vascular endothelial growth factor. CD 34 + cell fingers.[24] When arterial reconstructions are fashioned population of human omentum is supposed to be in the femoral region, at times, achieving soft tissue responsible for the clinical benefit of omental coverage of the reconstruction may be challenging. This transplantation by promoting angiogenesis.[17] is especially true when radical and wide debridement Omentopexy has been recently shown to promote has removed the nearby tissues normally used for this myocardial angiogenesis, the so-called Hybrid surgical purpose. In such circumstances, omentum reached from angiogenesis, wherein it enhances the angiogenesis behind the inguinal ligament and transposed over the induced by autologous bone marrow derived femoral triangle can help by obliterating the dead space mononuclear cell transplantation.[18] Omentopexy and and providing a surface for skin coverage.[25] cell patch cardiomyoplasty (impregnation of skeletal myoblasts from autologous rectus muscle into the PLASTIC AND RECONSTRUCTIVE SURGERY infarcted myocardium) in conjunction with coronary artery bypass surgery may stimulate myogenesis and The omentum continues to be a versatile reconstructive angiogenesis in the avascular, dyskinetic scar tissue of tool with increasing applications in the field of plastic the left ventricle, resulting in improved functional and reconstructive surgery. It can be used to correct a capacity.[19] In this era of cardiac valve replacement and variety of defects of the face and scalp. Full thickness coronary bypass surgeries, there are an increasing defects of the cheek can be repaired by a so-called number of sternal wound infections and mediastinitis. “omental sandwich technique,” wherein a flap of In such conditions when the usual modalities of omentum brought to the neck through a subcutaneous treatment like appropriate antibiotics, early debridement tunnel is used to cover the defect, followed by skin and transposition of muscle flaps prove unsatisfactory, grafting.[26] Laparoscopically harvested omental flaps can transposition of the is particularly well be used for head and neck reconstructions. In patients suited as it contains a large number of immunologically with a devascularized temporoparietal region, active cells with anti-infective activity.[20] In thoracic particularly when there is unavailability of the surgery, omentum is being widely used for filling up of contralateral temporoparietal fascia, total ear the dead spaces at chronic empyema, for chest wall reconstruction has been carried out using omental free reconstruction after extensive resections and to flaps.[27] Following extensive surgeries for strengthen a main bronchus stump in cases of failure pharyngoesophageal malignancies, tubed gastro-omental after pneumonectomy.[21] While managing chronic free flaps can be used for pharyngoesophageal empyema, omental flap transposition should be reconstruction.[28] The omentum can be safely harvested considered when both thoracic tube drainage and and reliably used to reconstruct a diverse range of thoracostomy prove to be ineffective. Due to the plastic extraperitoneal wounds and defects. It has a trophical and immunological features of the omentum, effect on the surrounding tissues, making it very useful intrathoracic omentoplasty is an effective means of in reconstructive procedures. Advanced breast cancer treatment of pleural cavity secondary to a stabilized is associated with pain, ulceration and bad odor. In such bronchial fistula.[22] During surgical attempts at curing patients with uncontrolled chest wall disease, radical lung tumors with carinal proximity, omentum can be chest wall surgery with omental flap transposition serves used to protect tracheobronchial anastomoses. as a good palliative procedure and a means of local Omentoplasty also prevents bronchial dehiscences control, provided they have an expectation of at least following lung transplantation. moderate-term survival.[29] Omental transfer restores epithelial cover after radical surgery and is especially VASCULAR SURGERY useful after previous irradiation injury. Omental flaps may be used for abdominal wall oncologic defect Omental pedicled flaps are commonly interposed reconstruction also, on account of their large size and between aortic reconstructions and the nearby small good vascularity. Especially when materials like Gore- bowel to prevent erosion, graft infection and aortoenteric Tex are used for large defect reconstructions, omentum fistula formation. Buerger’s disease is a progressive serves as an interpositional flap over the Gore-Tex repair, disabling disease of unpredictable course affecting young preventing exposure in the event of infection or flap smokers. Omentopexy by free or pedicled omental breakdown.[30] Transposed greater omentum can serve transfer is an attractive option for these patients. Many as a vascularized base for split-thickness skin grafts

138 Indian J Surg | June 2006 | Volume 68 | Issue 3 The omentum during reconstruction of soft tissue defects of groin and pyelovesicostomies. In diseases where the renal artery axilla. Extensive soft tissue defects of both the lower and hence the circulation of the kidney is affected, limbs can be resurfaced with free hemiflaps harvested omentum may be used to provide alternative blood from the omentum. Pedicled omentoplasty has been supply to the kidney so as to preserve renal function.[37] shown to prevent the formation of lymphedema after Following lymphorenal disconnection for chyluria, the pelvic lymph node dissection. This procedure is also omentum can be wrapped around the renal pedicle to useful in reducing the formation of lymphedema in the minimize the chances of postoperative lymphatic lower limbs following radiotherapy, by favoring the drainage and recurrence.[38] Because of its good absorptive absorption of lymph fluids.[31] Omentoplasty done capacity, the omentum is likely to absorb any lymphatic through a midline laparotomy and transferred to the ooze. Omentovesicopexy is a simple and efficient thigh either through the lower end of the laparotomy technique for the treatment of neurogenic dysfunctions incision or through a separate stab and placed of the urinary bladder. In this technique, the greater subcutaneously in the upper third of the thigh has been omentum helps in the reinnervation and tried as a primary procedure as well as after failed revascularization of the bladder.[39] lymphonodo-venous shunt to reduce the edema in patients with unilateral filarial lymphedema.[32] A new composite gastric seromuscular and omental pedicle flap has been described to provide immediate The high vascularity of the omentum, coupled with its watertight and airtight closure in the repair of complex rich content of microvascular endothelial cells and defects of urethra. This flap was used to repair defects adipocytes that produce large amounts of vascular of urethra, scrotum and abdominal wall in a patient with endothelial growth factor, paves way for its usefulness in Fournier’s gangrene.[40] During the surgical management soft tissue augmentation procedures. Transplantation of of high undescended testes, omentotesticulopexy has fragmented omental tissues or co-transplantation with been recommended either before or concomitant with preadipocytes promises a new and exciting horizon for spermatic vessel division, so as to improve the vascular soft tissue augmentation.[33] Omentum can be used to supply and reduce the rate of testicular atrophy.[41] vascularize skin, a skin flap or a bone graft to obtain secondary island flaps. The clinical applications of these GYNECOLOGICAL SURGERY flaps are immense in the field of reconstructive surgery. Following radical abdominal hysterectomy, the omental Wrapping the median nerve with vascularized omentum J-flap is a rapid and effective means of minimizing is a viable option for the treatment of severe recalcitrant surgical morbidity and reducing postoperative carpal tunnel syndrome.[34] This is especially helpful complications like pelvic infection, abscess or intestinal while dealing with a carpal tunnel that has earlier obstruction and merits consideration for routine undergone multiple operations with diffuse scar and placement at the end of the surgery.[42] Following radical adherence over an extended length of the median nerve. pelvic exenteration for gynecological malignancies, neovaginal reconstruction can be done using an omental UROLOGICAL AND GENITAL SURGERY cylinder flap lined with a split-thickness skin graft. This procedure has distinct advantages over Omentum is also being used in the field of urological reconstruction with myocutaneous flaps, by providing surgery. Open insertion of the support for the pelvic floor with primary healing along catheters is the conventional method adopted during with potential for sexual function with minimal continuous ambulatory peritoneal dialysis (CAPD), an morbidity.[43] Obstetric trauma, radiotherapy and radical effective treatment modality for patients with end-stage gynecological surgeries can lead to a variety of renal diseases. Instead, laparoscopic omental fixation vesicovaginal fistulae. Surgical procedures using to the parietal and then extraperitoneal omentum merit consideration in the management of placement of the straight portion of the catheter, helps these fistulae. Omental flaps can reach well into the to avoid many complications like catheter tip migration, pelvis through the retrocolic route and therefore can pericathetral leakage and severe abdominal pain caused be used for perineal reconstruction following radical by periodic catheter movement.[35] Following renal vulvectomy.[44] transplantation, lymphoceles form in about 5-15% of the cases in spite of meticulous surgical techniques. ORTHOPEDIC SURGERY Peritoneal fenestration of the lymphoceles combined with interposition of greater omentum is a procedure that Osteoradionecrosis, earlier described as “osteomyelitis merits consideration in managing this complication.[36] secondary to radiation,” refers to the fibrosis of the Omental interposition has also been used for prevention underlying bony structures in irradiated sites. Pedicled of urinary fistulas in cases of lower pole renal artery omentoplasty and split- thickness skin grafting has been lesions and feared ureteral necrosis as well as for successfully tried for infected osteoradionecrotic ulcers protection of pyeloureterostomies and that fail to respond to antibiotics[45] and as a palliative

Indian J Surg | June 2006 | Volume 68 | Issue 3 139 Alagumuthu M, et al. procedure for control of pain and bleeding. This modality 8. De Broux E, Parc Y, Rondelli F, Dehni N, Tiret E, Parc R. Sutured is very impressive for the elderly and the debilitated Perineal Omentoplasty after Abdominoperineal resection for patients. Greater omentum can be used as a plastic and Adenocarcinoma of the lower rectum. Dis Colon Rectum 2005;48:476-81. disinfecting material in combination with laser radiation 9. Di Giorgio A, Biacchi D, Sibio S, Accarpio F, Sinibaldi G, Petrella in the management of chronic osteomyelitis of the ribs L, et al. Abdominal rectopexy for complete rectal prolapse: and sternum. Omentoplasty is the method of choice in Preliminary results of a new technique. Int J Colorectal Dis surgical treatment of purulent lesions of costal cartilage 2005;20:180-9. and sternum. The omentum can be used as a gliding 10. Goldsmith HS, Chen WF, Duckett SW. Brain vascularization by intact omentum. Arch Surg 1973;106:695-8. material to prevent re-adhesions following tenolysis after 11. Rafael H, Mego R, Moromizato P, Garcia W. Omental major forearm replantations.[46] Omental free-tissue Transplantation for Temporal lobe Epilepsy: Report of two transfer employing microsurgical techniques has been cases. Neurol India 2002;50:71-4. used in the management of brachial plexus injury 12. Rafael H, Mego R, Moromizato P, Espinoza M. Omental pain.[47] transplantation for Alzheimer’s disease. Neurol India 2000;48:319-21. 13. Yoshioka N, Tominaga S, Suzuki Y, Yamazato K, Hirano S, CONCLUSION Nonaka K, et al. Cerebral revascularization using omentum and muscle free flap for ischemic cerebrovascular disease. Until the 1800s, the role and functions of the omentum Surg Neurol 1998;49:58-65. continued to be a mystery. Since the early 1900s, the 14. Normington EY, Papay FA, Yetman RJ. Treatment of recurrent cerebrospinal fluid rhinorrhea with a free vascularised omental surgical world started recognizing and appreciating the flap: A case report. Plast Reconstr Surg 1996;98:514-9. great potentials of this ‘wonder’ organ. The extra- 15. Goldsmith HS. Brain and spinal cord revascularization by abdominal uses of omentum were first addressed in the omental transposition. Neurol Res 1994;16:159-62. 1930s. The omental lengthening procedures described 16. Duffill J, Buckley J, Lang D, Neil-Dwyer G, Mcginn F, Wade D. by Ross and Pardo in dog were great contributions to Prospective study of omental transposition in patients in patients with chronic spinal injury. J Neurol Neurosurg this field. Now, by a simple procedure, the omentum Psychiatr 2001;71:73-80. can be converted into a vascularized pedicle graft, which 17. Garcia-Gomez I, Goldsmith HS, Angulo J, Prados A, Lopez- can be put to use throughout the body. The omentum is Hervas P, Cuevas B, et al. Angiogenic capacity of human undoubtedly the most versatile organ in that it finds omental stem cells. Neurol Res 2005;27:807-11. wide applications in almost all branches of surgery. Its 18. Kanamori T, Watanabe G, Yasuda T, Nagamine H, Kamiya H, Koshida Y. Hybrid surgical angiogenesis: Omentopexy can various special attributes make it an extremely useful enhance myocardial angiogenesis induced by cell therapy. Ann adjunct in several difficult surgical situations. Hence, Thorac Surg 2006;81:160-7. we strongly recommend that in this fast growing surgical 19. Taheri SA, Ashraf H, Merhige M, Miletich RS, Satchidanand field, the wise operating surgeon constantly and S, Malik C, et al. Myoangiogenesis after cell patch adequately keeps updating his knowledge on these cardiomyoplasty and omentopexy in a patient with ischemic useful concepts and makes the best use of them as and cardiomyopathy. Tex Heart Inst J 2005;32:598-601. 20. Krabatsch T, Schmitt DV, Mohr FW, Hetzer R. Thoracic when applicable. transposition of the greater omentum as an adjunct in the treatment of mediastinitis-pros and cons within the context REFERENCES of a randomized study. Eur J Surg Suppl 1999;584:45-8. 21. Levashev YN, Akopov AL, Mosin IV. The possibilities of greater 1. Thakur B, Zhang CS, Tan ZB. Omentoplasty versus no omentum usage in thoracic surgery. Eur J Cardiothorac Surg omentoplasty for esophagogastrostomy after surgery for 1999;15:465-8. cancer of cardia and esophagus. Indian J Cancer 2004;41:167­ 22. Politi L, Scanagatta P, Salani A, Montinaro F, Turini A, Crisci C. 9. Intrathoracic omentoplasty in the treatment of pleural cavity 2. Madiba TE, Nair R, Mulaudzi TV, Thomson SR. Perforated secondary to stabilized bronchial fistula. Minerva Chir gastric ulcer – Reappraisal of surgical options. South Afr J 2004;59:495-9. Surg 2005;43:58-60. 23. Talwar S, Choudhary SK. Omentopexy for limb salvage in 3. Raj BR, Subbu K, Manoharan G. Omental plug closure of Buerger’s disease: Indications, technique and results. J large duodenal defects- An experimental study. Trop Postgrad Med 2001;47:137-42. Gastroenterol 1997;18:180-2. 24. Ala-Kulju K, Virkkula L. Use of omental pedicle for treatment 4. Maeda A, Ebata T, Kanemoto H, Matsunaga K, Bando E, of Buerger’s disease affecting the upper extremities. A modified Yamaguchi S, et al. Omental flap in pancreaticoduodenectomy technique. Vasa 1990;19:330-3. for protection of splanchnic vessels. World J Surg 25. Mendes D, Kahn M, Ibrahim IM, Sussman B, Fox R, Dardik 2005;29:1122-6. H. Omental protection of autogenous arterial reconstruction 5. Reza MS, Khoshnevis J, Kharazm P. Surgical treatment of following femoral prosthetic graft infection. J Vas Surg hydatid cyst of the liver: Drainage versus omentoplasty. Ann 1985;2:603-6. Hepatol 2005;4:272-4. 26. Harashina T, Imai T, Wada M. The omental sandwich 6. Zbar AP, Hariharan S, Warner C. Omentoplasty for liver abscess reconstruction for a full-thickness cheek defect. Plast Reconstr complicating perforative colonic Diverticulum. Tech Surg 1979;64:411-5. Coloproctol 2003;7:222. 27. Park C, Roh TS, Chi HS. Total ear reconstruction in the 7. Levy Y, Miko I, Hauck M, Mathesz K, Furka I, Orda R. devascularized temporoparietal region: Use of omental free Effect of Omental Angiogenic Lipid Factor on flap. Plast Reconstr Surg 2003;111:1391-7. Revascularization of Auto transplanted Spleen in Dogs. Eur 28. Genden EM, Kaufman MR, Katz B, vine A, Urken ML. Tubed Surg Res 1998;30:138-43. Gastro-omental free flap for Pharyngoesophageal

140 Indian J Surg | June 2006 | Volume 68 | Issue 3 The omentum

Reconstruction. Arch Otolaryngol Head Neck Surg and recurrence after lymphorenal disconnection for chyluria. 2001;127:847-53. BJU Int 2004;94:673-4. 29. Henderson MA, Burt JD, Jenner D, Crookes P, Bennett RC. 39. Mokhort VA, Makarov VN. Omentovesicopexy with Radical surgery with omental flap for uncontrolled locally transposition of the bladder into the abdominal cavity in the recurrent breast cancer. ANZ J Surg 2001;71:675-9. treatment of neurogenic bladder. Urol Nefrol 1990;4:20-4. 30. Wong CH, Tan BK, Koong HN, Lim CH, Chia SJ, Song C. Use 40. Kamei Y, Aoyama H, Yokoo K, Fujii K, Kondo C, Sato T, et al. of omentum flap as additional soft tissue cover for abdominal Composite gastric seromuscular and omental pedicle flap for wall defects reconstructed with Gore-Tex. Plast Reconstr Surg urethral and scrotal reconstruction after Fournier’s gangrene. 2005;116:1715-20. Ann Plast Surg 1994;33:565-8. 31. Benoit L, Boichot C, Cheynel N, Arnould L, Chauffert B, 41. Shoshany G, Shofty R, Livne E, Hayari L, Mordechovitz D. Cuisenier J, et al. Preventing lymphedema and morbidity with Testicular neovascularization by “omentotesticulopexy”: A an omentum flap after ilioinguinal lymphnode dissection. possible adjuvant in the surgical correction of high Ann Surg Oncol 2005;12:793-9 undescended testes. J Pediatr Surg 1996;31:1229-32. 32. Binoy C, Rao YG, Ananthakrishnan N, Kate V, Yuvaraj J, Pani 42. Patsner B, Hackett TE. Use of the omental J-flap for prevention SP. Omentoplasty in the management of filarial lymphoedema. of postoperative complications following radical abdominal Trans R Soc Trop Med Hyg 1998;92:317-9. hysterectomy: Report of 140 cases and literature review. 33. Masuda T, Furue M, Matsuda T. Novel strategy for soft tissue Gynecol Oncol 1997;65:405-7. augmentation based on transplantation of fragmented 43. Kusiak JF, Rosenblum NG. Neovaginal reconstruction after omentum and preadipocytes. Tissue Eng 2004;10:1672-83. exenteration using an omental flap and split-thickness skin 34. Goitz RJ, Steichen JB. Microvascular omental transfer for graft. Plast Reconstr Surg 1996;97:775-81. the treatment of severe recurrent median neuritis of the 44. Shylasree TS, Karandikar S, Freites O, Mcgregor I, Carr ND. wrist: a long-term follow-up. Plast Reconstr Surg Omentopexy for reconstruction of the perineum following a 2005;115:163-71. radical vulvectomy: A case report. Int J Gynecolog Can 35. Ogunc G. Minilaparoscopic extraperitoneal tunneling with 2004;14:1122-5. omentopexy: A new technique for CAPD catheter placement. 45. Sato M, Tanaka F, Wada H. Treatment of necrotic infection on Perit Dial Int 2005;25:551-5. the anterior chest wall secondary to mastectomy and 36. Mohring K, Pomer S. Preventive use of pedicled omentum postoperative radiotherapy by the application of omentum majus within the scope of kidney transplantation. Helv Chir and mesh skin grafting. Surg Today 2002;32:261-3. Acta 1991;58:265-70. 46. Ueda K, Harashina T, Harada T, Oba S, Nagasaka S. Omentum 37. Lesznyak T, Nemeth N, Brath E, Peto K, Pekar G, Nagy D, et al. as gliding material after extensive forearm tenolysis. Br J Plast Kidney neovascularization by the greater omentum after Surg 1993;46:590-3. pretreatment with omental angiogenic factor. Magy Seb 47. Ciuce C, Seddiq F, Fodor M, Constantinescu D, Todoran M, 2005;58:129-33. Andercou A, et al. Omental free-tissue transfer: Indications 38. Dalela D, Gupta VP, Goel A, Singh KM. Omental wrap around and results from personal experience. Microsurgery the renal pedicle: An adjunctive step to minimize morbidity 2003;23:198-205.

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Indian J Surg | June 2006 | Volume 68 | Issue 3 141