Single Port Laparoscopic Harvest of Omental Flap for Reconstruction of Refractory Wound

Keiichi Fujino, MD, PhD, Masatoshi Hashimoto, MD, Ryo Murabayashi, MD, Masashi Nabetani, MD, Kazuhito Mita, Hideki Asakawa, MD, Akira Kamasako, MD, PhD, Kazuya Koizumi, MD, Takashi Hayashi, MD, PhD, Hideto Ito, MD, PhD

Department of Surgery, New Tokyo Hospital, Japan

Introduction: Single-port laparoscopic surgery (SPLS) might be an ideal procedure for reduced port surgery. The omentum is a useful reconstructive tissue because of its rich vascularity, lymphatic supply, and angiogenic capacity. Herein we report two cases of omental harvest in which SPLS technique was applied.

In case 1, a 65-year-old woman who underwent left standard radical mastectomy with radiation therapy developed the infected ulceration with irradiated supra-clavicular region and the pulmonary fistula 23 years later. Because of infection and bleeding wound, an urgent debridement was performed with resection of the clavicula and the first rib.

In case 2, a 31-year-old woman who underwent craniotomy for tuberculum sellae meningioma developed refractory osteomyelitis.

Operative procedure: A 3-cm transumbilical incision was made and the abdominal cavity was accessed. The port device for SPLS was made with a Wound Retractor and a surgical glove. We dissected the greater omentum along with the right gastroepiploic vessel through the umbilical incision. And then, a free graft of omentum was used to fill the huge cavity. The vessel of omental flap was microscopically anastomosed. The omentum flap was covered with a split thickness skin graft. The duration of the SPLS procedures was 75 minutes. Both patients had dramatic general clinical condition such as optimal wound healing. Conclusion: The main advantages of using an omental flap are its large size and bulk to fill large dead spaces, long pedicle, and rich vascular and lymphatic networks. Single port laparoscopic omentoplasty is feasible and safe. This approach mandates close collaboration between the plastic and the laparoscopic surgeons. We suggest it may be an effective management for refractory wound.

Session: Poster Presentation

Program Number: P483

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