Application of pedicled omentum flap in breast reconstruction of breast cancer patients_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WAN Nengbin ¹ , LIU Dequan ² , LU Lingli ¹ , HE Xiao ¹ , SONG Dajiang ³ , LI Zan ³ , ZHOU Xiao ³ , PENG Wen ³ , LIU Zeyang ³

1. Department of Breast Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China;
2. The First Department of Breast Surgery, Yunnan Province Cancer Hospital, the Third Affiliated Hospital of Kunming School of Medicine, Kunming Yunnan, 650000, P.R.China;
3. Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China;

Corresponding author：

WAN Nengbin, Email: johnsondan@163.com

Keywords：

Breast cancer; pedicled omentum flap; breast reconstruction

DOI：

10.7507/1002-1892.201901007

Video：

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Objective To explore the clinical application of the pedicled omentum flap in breast reconstruction of breast cancer patients. Methods Between May 2013 and October 2017, 205 patients with breast cancer received modified mastectomy. The pedicled omentum flap was used to reconstruct breast at the same time. All patients were female with an average age of 34.9 years (mean, 26-58 years). The tumor located at left breast in 127 cases and right side in 78 cases. The diameter of the tumor was 2-5 cm (mean, 2.9 cm). The 120 cases of breast cancer were at stage Ⅰ and 85 cases were at stage Ⅱ; and 126 cases were invasive ductal carcinoma and 79 cases were invasive lobular carcinoma. The course of disease ranged from 10 to 92 days (mean, 38.5 days). The size of defect after tumor ablation ranged from 9 cm× 6 cm to 18 cm×12 cm; the size of pedicled omentum flap ranged from 18 cm×10 cm to 22 cm×16 cm. Results According to the anatomical basis, the omentum was divided into 4 types, including thin type (42 cases, 20.5%), medium type (133 cases, 64.9%), hypertrophy type (24 cases, 11.7%), and absence type (6 cases, 2.9%). All omentum flaps survived successfully and the incisions healed by first intention. All patients were followed up 6-74 months (mean, 24.5 months); 83 cases were followed up more than 5 years. The shape, texture, and elasticity of the reconstructed breast were good and no flap contracture deformation happened. Only linear scar left at the donor sites, and the function of abdomen was not affected. No local recurrence happened. Conclusion The pedicled omentum flap can be harvested safely and reliable, which is the one of ideal option for breast reconstruction in breast cancer patients.

Citation： WAN Nengbin, LIU Dequan, LU Lingli, HE Xiao, SONG Dajiang, LI Zan, ZHOU Xiao, PENG Wen, LIU Zeyang. Application of pedicled omentum flap in breast reconstruction of breast cancer patients. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(8): 1006-1010. doi: 10.7507/1002-1892.201901007 Copy

1.	McLean DH, Buncke HJ Jr. Autotransplant of omentum to a large scalp defect, with microsurgical revascularization. Plast Reconstr Surg, 1972, 49(3): 268-274.
2.	Upton J, Mulliken JB, Hicks PD, et al. Restoration of facial contour using free vascularized omental transfer. Plast Reconstr Surg, 1980, 66(4): 560-569.
3.	Jurkiewicz MJ, Nahai F. The omentum: its use as a free vascularized graft for reconstruction of the head and neck. Ann Surg, 1982, 195(6): 756-765.
4.	Li X, Ouyang Z, Yang S, et al. Omental transplantation improves surgical outcome of large squamous cell carcinoma: A case report. Oncol Lett, 2015, 9(6): 2805-2808.
5.	Jimenez AG, St Germain P, Sirois M, et al. Free omental flap for skin-sparing breast reconstruction harvested laparoscopically. Plast Reconstr Surg, 2002, 110(2): 545-551.
6.	Arnold PG, Hartrampf CR, Jurkiewicz MJ. One-stage reconstruction of the breast, using the transposed greater omentum. Case report. Plast Reconstr Surg, 1976, 57(4): 520-522.
7.	Hoffmann J, Wallwiener D. Classifying breast cancer surgery: a novel, complexity-based system for oncological, oncoplastic and reconstructive procedures, and proof of principle by analysis of 1225 operations in 1166 patients. BMC Cancer, 2009, 9: 108.
8.	Munhoz AM, Montag E, Arruda E, et al. Assessment of immediate conservative breast surgery reconstruction: a classification system of defects revisited and an algorithm for selecting the appropriate technique. Plast Reconstr Surg, 2008, 121(3): 716-727.
9.	Kronowitz SJ, Kuerer HM, Buchholz TA, et al. A management algorithm and practical oncoplastic surgical techniques for repairing partial mastectomy defects. Plast Reconstr Surg, 2008, 122(6): 1631-1647.
10.	Zaha H, Inamine S, Naito T, et al. Laparoscopically harvested omental flap for immediate breast reconstruction. Am J Surg, 2006, 192(4): 556-558.
11.	Zaha H, Sunagawa H, Kawakami K, et al. Partial breast reconstruction for an inferomedial breast carcinoma using an omental flap. World J Surg, 2010, 34(8): 1782-1787.
12.	宋向阳, 管丹丹, 林辉, 等. 乳腺癌保乳术后腹腔镜带蒂网膜瓣一期乳房重建术. 中华整形外科杂志, 2011, 27(6): 401-405.
13.	宋达疆, 李赞, 周晓, 等. 股薄肌皮瓣联合大收肌穿支皮瓣在乳房重建中的应用. 中国修复重建外科杂志, 2018, 32(6): 707-713.
14.	Arnold PG, Witzke DJ, Irons GB, et al. Use of omental transposition flaps for soft-tissue reconstruction. Ann Plast Surg, 1983, 11(6): 508-512.
15.	Cartier R, Brunette I, Hashimoto K, et al. Angiogenic factor: a possible mechanism for neovascularization produced by omental pedicles. J Thorac Cardiovasc Surg, 1990, 99(2): 264-268.
16.	Gallagher J, Webb A, Ilankovan V. Gastro-omental free flaps in oral and oropharyngeal reconstruction: surgical anatomy, complications, outcomes. Br J Oral Maxillofac Surg, 2002, 40(1): 32-36.
17.	Das SK. The size of the human omentum and methods of lengthening it for transplantation. Br J Plast Surg, 1976, 29(2): 170-174.
18.	Das SK. Assessment of the size of the human omentum. Acta Anat (Basel), 1981, 110(2): 108-112.
19.	Horch RE, Horbach T, Lang W. The nutrient omentum free flap: revascularization with vein bypasses and greater omentum flap in severe arterial ulcers. J Vasc Surg, 2007, 45(4): 837-840.
20.	Vyas RM, Prsic A, Orgill DP. Transdiaphragmatic omental harvest: a simple, efficient method for sternal wound coverage. Plast Reconstr Surg, 2013, 131(3): 544-552.
21.	Hakelius L. Fatal complication after use of the greater omentum for reconstruction of the chest wall: case report. Plast Reconstr Surg, 1978, 62(5): 796-797.

1. McLean DH, Buncke HJ Jr. Autotransplant of omentum to a large scalp defect, with microsurgical revascularization. Plast Reconstr Surg, 1972, 49(3): 268-274.
2. Upton J, Mulliken JB, Hicks PD, et al. Restoration of facial contour using free vascularized omental transfer. Plast Reconstr Surg, 1980, 66(4): 560-569.
3. Jurkiewicz MJ, Nahai F. The omentum: its use as a free vascularized graft for reconstruction of the head and neck. Ann Surg, 1982, 195(6): 756-765.
4. Li X, Ouyang Z, Yang S, et al. Omental transplantation improves surgical outcome of large squamous cell carcinoma: A case report. Oncol Lett, 2015, 9(6): 2805-2808.
5. Jimenez AG, St Germain P, Sirois M, et al. Free omental flap for skin-sparing breast reconstruction harvested laparoscopically. Plast Reconstr Surg, 2002, 110(2): 545-551.
6. Arnold PG, Hartrampf CR, Jurkiewicz MJ. One-stage reconstruction of the breast, using the transposed greater omentum. Case report. Plast Reconstr Surg, 1976, 57(4): 520-522.
7. Hoffmann J, Wallwiener D. Classifying breast cancer surgery: a novel, complexity-based system for oncological, oncoplastic and reconstructive procedures, and proof of principle by analysis of 1225 operations in 1166 patients. BMC Cancer, 2009, 9: 108.
8. Munhoz AM, Montag E, Arruda E, et al. Assessment of immediate conservative breast surgery reconstruction: a classification system of defects revisited and an algorithm for selecting the appropriate technique. Plast Reconstr Surg, 2008, 121(3): 716-727.
9. Kronowitz SJ, Kuerer HM, Buchholz TA, et al. A management algorithm and practical oncoplastic surgical techniques for repairing partial mastectomy defects. Plast Reconstr Surg, 2008, 122(6): 1631-1647.
10. Zaha H, Inamine S, Naito T, et al. Laparoscopically harvested omental flap for immediate breast reconstruction. Am J Surg, 2006, 192(4): 556-558.
11. Zaha H, Sunagawa H, Kawakami K, et al. Partial breast reconstruction for an inferomedial breast carcinoma using an omental flap. World J Surg, 2010, 34(8): 1782-1787.
12. 宋向阳, 管丹丹, 林辉, 等. 乳腺癌保乳术后腹腔镜带蒂网膜瓣一期乳房重建术. 中华整形外科杂志, 2011, 27(6): 401-405.
13. 宋达疆, 李赞, 周晓, 等. 股薄肌皮瓣联合大收肌穿支皮瓣在乳房重建中的应用. 中国修复重建外科杂志, 2018, 32(6): 707-713.
14. Arnold PG, Witzke DJ, Irons GB, et al. Use of omental transposition flaps for soft-tissue reconstruction. Ann Plast Surg, 1983, 11(6): 508-512.
15. Cartier R, Brunette I, Hashimoto K, et al. Angiogenic factor: a possible mechanism for neovascularization produced by omental pedicles. J Thorac Cardiovasc Surg, 1990, 99(2): 264-268.
16. Gallagher J, Webb A, Ilankovan V. Gastro-omental free flaps in oral and oropharyngeal reconstruction: surgical anatomy, complications, outcomes. Br J Oral Maxillofac Surg, 2002, 40(1): 32-36.
17. Das SK. The size of the human omentum and methods of lengthening it for transplantation. Br J Plast Surg, 1976, 29(2): 170-174.
18. Das SK. Assessment of the size of the human omentum. Acta Anat (Basel), 1981, 110(2): 108-112.
19. Horch RE, Horbach T, Lang W. The nutrient omentum free flap: revascularization with vein bypasses and greater omentum flap in severe arterial ulcers. J Vasc Surg, 2007, 45(4): 837-840.
20. Vyas RM, Prsic A, Orgill DP. Transdiaphragmatic omental harvest: a simple, efficient method for sternal wound coverage. Plast Reconstr Surg, 2013, 131(3): 544-552.
21. Hakelius L. Fatal complication after use of the greater omentum for reconstruction of the chest wall: case report. Plast Reconstr Surg, 1978, 62(5): 796-797.

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