49904 Omental flap, extra-abdominal (eg, for reconstruction of sternal and chest wall defects)

Name of the Procedure:

Omental Flap, Extra-Abdominal (e.g., for Reconstruction of Sternal and Chest Wall Defects)

Summary

An omental flap is a surgical procedure in which a portion of the omentum (a layer of fatty tissue that drapes over the abdominal organs) is used to reconstruct defects in the chest wall, such as those caused by surgery, trauma, or infection. The flap provides a rich blood supply that aids in healing and tissue regeneration.

Purpose

The procedure addresses defects in the sternal area and chest wall, often resulting from surgeries, trauma, or infections. The goal is to reconstruct and restore the structural integrity of the chest wall, promote healing, and prevent or manage infections.

Indications

• Large sternal or chest wall defects.
• Chronic infections in the chest wall.
• Necrotizing infections or osteomyelitis of the sternum.
• Failed previous reconstruction surgeries.

Preparation

• Fasting typically required for 8-12 hours before the procedure.
• Adjustments may be needed for medications, especially blood thinners.
• Preoperative imaging studies such as CT scans or MRIs.
• Blood tests and other assessments to ensure the patient is fit for surgery.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the abdomen to access the omentum.
3. A portion of the omentum is carefully mobilized while preserving its blood supply.
4. The omentum is tunneled to the chest wall defect or transferred in a manner that reaches the defect.
5. The omentum is then secured over the chest wall defect.
6. Closure of the abdominal incision is performed.
7. The chest wall is closed and dressed appropriately.

Duration

The procedure typically takes 3 to 5 hours, depending on the complexity of the defect and the patient's condition.

Setting

The procedure is performed in a hospital's surgical suite.

Personnel

• Surgeons (often plastic or thoracic surgeons)
• Anesthesiologists
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma
• Delayed wound healing
• Damage to surrounding organs or tissues
• Hernia at the donor site
• Complications from anesthesia

Benefits

• Effective reconstruction of large chest wall defects.
• Increased blood supply promoting faster and more effective healing.
• Reduced risk of infection in the reconstructed area.
• Improved functional and aesthetic outcomes.

Recovery

• Hospital stay of several days post-procedure.
• Pain management with medications.
• Instructions on wound care, activity limitations, and signs of complications.
• Follow-up appointments for wound inspection and suture removal.
• Full recovery may take several weeks, with activity restrictions gradually lifted.

Alternatives

• Synthetic mesh or other prosthetic materials for chest wall reconstruction.
• Muscle flap procedures (e.g., pectoralis major flap).
• Conservative management with antibiotics alone in case of infections.
• Pros and cons: Synthetic materials may not integrate as well and have higher infection risks; muscle flaps might not provide as robust blood supply as the omental flap.

Patient Experience

• During the procedure: The patient will be under general anesthesia and will not feel any pain.
• After the procedure: Pain and discomfort at the surgical sites, managed with medications.
• Movement might be restricted initially, with a gradual return to normal activities as healing progresses. Regular pain assessments and management measures to ensure comfort.