Free Transplant of Greater Omentum

The greater omentum is a layer of structure in the peritoneal cavity with rich blood supply, lymphatics and fats. Under normal circumstances, it does not manifest performance of any important function and is seldom noticed. Initially, it was regarded as a structure to keep the body warm and as a buffer to protect the organs in the peritoneal cavity when there were external disturbances. At the end of the 19th century, Bennet (1894) first reported a case of perforated stomach repaired with greater omentum. In 1906, Morrison discovered that the greater omentum was able to migrate towards inflammed sites, close up perforated holes, limit the infective sites and supply blood to the healing tissues. Thus it was called the ‘policeman of the peritoneal cavity’. In 1936, O’Shanghnessy transplanted the greater omentum with intact pedicle to the cardiac muscle, attempting to improve the myocardial ischaemia and obtained some success in preventing recurrence of angina. Walter in 1937 applied it in treating the more complicated cases of cardiac ischaemia. Thompson in 1945 used it to treat bronchial fistulae and obtained successful results. In 1967, Goldsmith and Santos cut of the left gastro-epiploic artery and vein from the greater omentum and freed the omentum from the greater gastric curvature and transverse colon. The right gastro-epiploic artery and vein were used as a vascular pedicle which was tailored into a bandage form according to the distribution of vascular network. It was then pulled out of the peritoneal cavity from a small incision in the abdominal muscles to reach the groin region and space between the thigh muscles. It was hoped that this would improve the stagnant lymphatic or venous return from the lower limbs, in chronic lymphatic obstruction or other diseases of circulatory impairments in the lower limbs. In 1972, Dupont et al treated a patient with a large, deep, irradiated ulcer on the chest wall with omental graft. After separating one side of the greater omentum, the other gastro-epiploic artery and vein were reserved as a vascular pedicle. It was pulled out of the peritoneal cavity from an incision on the upper abdominal wall and reached the chest wall through a subcutaneous tunnel. It was then used to cover the debrided wound in the chest wall. Subsequently, skin grafts of medium thickness were applied on the greater omentum. After the operation, all the skin grafts transplanted on the greater omentum survived and complete cure in the ulcerated area was achieved…