The omental free flap and flow-through flap: pre-operative evaluation of right gastro-omental artery on multidetector co
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TECHNICAL
The omental free flap and flow‑through flap: pre‑operative evaluation of right gastro‑omental artery on multidetector computed tomography Nicla Settembre1,2 · Zakariyae Bouziane1 · Damien Mandry3,4 · Marc Braun4,5 · Sergueï Malikov1,2
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background The gastro-omental artery (GOA) and the greater omentum are nowadays commonly used in many reconstructive surgeries, including cardiac, vascular, and plastic surgery. There are cases in which the GOA is found to be unsuitable only after partial harvesting following an upper laparotomy, and an improved method of pre-operative evaluation is required to eliminate the need for intraoperative small laparotomy. Methods Multidetector computed tomography was performed for 30 consecutive patients admitted for lower limb ischemia in a routine pre-operative evaluation of lower limb peripheral arterial disease (PAD). The origin of the GOA was checked on coronal and sagittal slices, its pathway was identified on the three-dimensional rendering. We assessed length and mean diameter of the distal and proximal right GOA, and the mean distances between the origins of GOA and the omental branches. Finally, we report one case of omental flow-through flap. Results 30 patients were included in our study. Routine pre-operative MDCT during lower limb PAD workup enabled identification of GOA in all cases. The mean internal diameter of the GOA at its origin was 3.3 mm (± 3.3). The mean internal diameter of the distal GOA was 1.26 mm (± 0.3). At least one omental descending branch was detected in every case and in 63% (19 patients) at least two branches were visualized. Conclusion Routine pre-operative angio-MDCT imaging is an effective tool to assess precisely the different anatomical properties of the GOA. This exam could be useful for both diagnosis of lower limb PAD and evaluation of the GOA suitability for flow-through flap lower limb revascularisation. Keywords Radio anatomical study · Gastro-omental artery · Greater omentum · Arteria omentalismagna · Multidetector computed tomography
Introduction
* Nicla Settembre [email protected] 1
Department of Vascular Surgery, Nancy University Hospital, University of Lorraine, 1, rue du Morvan, 54500 Vandoeuvre les Nancy, France
2
INSERM 1116, University of Lorraine, Nancy, France
3
Department of Radiology, Nancy University Hospital, University of Lorraine, Nancy, France
4
INSERM 947 (IADI), Nancy University Hospital, Nancy, France
5
Department of Anatomy, Nancy University, University of Lorraine, Nancy, France
Since the first description of greater omentum utilization in visceral surgery in 1896, many surgical specialties expanded clinical applications of this tissue in reconstructive surgery. Indeed, in the peritoneal cavity, the defensive role of the omentum has long been recognized. This property was widely applied to use the greater omentum as a coverage flap for tissue loss in different areas of the body. The greater omentum
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