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The greater omentum, due to its size and dependable blood supply, has long been utilized for treating pleural space problems. It has many unique properties that are not shared by other types of flaps such as muscle, pericardium, or pleura. The omentum has been shown to have angiogenic factors that can increase neovascularization of the tissue that is being repaired and it is also felt to have specific immunologic properties that allow it to augment local lymphocyte counts.
Additionally, it does not cause the same cosmetic or functional impairments as muscle flaps and its bulk and shape allow it to fill large spaces.
The omentum is a versatile organ and its uses include treating bronchial-pleural fistulas, space defects associated with empyemas, threatened airway anastomoses, esophagogastrostomy after esophagogastrectomy, poststernotomy mediastinal infections, and tracheoesophageal fistulas. Contraindications for omental pedicle flaps include previous major abdominal operations, cirrhosis with portal hypertension, and omental disorders. In addition, the omental “bulk” may not be sufficient for repairing many intrathoracic complications in extremely cachectic patients.
In summary, the omentum is an excellent choice for repairing a wide range of thoracic defects. Various approaches include an upper midline incision, laparoscopy, or thoracotomy with a transdiaphragmatic incision. The author currently favors an upper midline incision, in the supine position, followed by a thoracotomy, in the lateral decubitus position. Complications associated with omental harvest are rare and include ileus, bowel obstruction, gastric outlet obstruction, diaphragmatic herniation, omental necrosis, and abdominal fascial dehiscence. One must remember that many patients requiring an omental flap are already ill, due to their previous complication, and therefore, great care must be taken during omental harvesting to avoid further problems.
Hybrid surgical angigenesis: Omentopexy can enhance myocardial angiogenesis induced by cell therapy.