Free omental flap with microvascular anastomosis
CPT4 code
Name of the Procedure:
Free Omental Flap with Microvascular Anastomosis
Summary
The free omental flap with microvascular anastomosis is a surgical procedure that involves transferring a segment of the omental tissue (a layer of fatty tissue that drapes over the abdominal organs) to a different part of the body. This transferred tissue, or "flap," is reconnected to the blood vessels at the recipient site using microsurgical techniques.
Purpose
The procedure is typically performed to reconstruct tissue defects caused by trauma, infection, or cancer surgeries, and to promote healing in areas with poor blood supply. The goals include improving blood flow, enhancing tissue healing, and restoring function and appearance to the affected area.
Indications
- Large soft tissue defects
- Non-healing wounds
- Reconstructive surgery post-tumor excision
- Complex wounds with poor vascularization
Preparation
- The patient may be instructed to fast for 8-12 hours before the procedure.
- Preoperative assessments including blood tests, imaging studies, and possibly a preoperative anesthetic evaluation.
- The patient should discuss any medications with their doctor, as some may need to be adjusted or stopped.
Procedure Description
- The patient is placed under general anesthesia.
- An incision is made in the abdomen to access the omental tissue.
- A segment of the omentum is carefully dissected and isolated while preserving its blood supply.
- The omental flap is detached from its original blood supply.
- The flap is then transferred to the recipient site, where it is microvascularly anastomosed to local blood vessels using a microscope and fine surgical instruments.
- The donor and recipient sites are carefully closed with sutures or staples.
Duration
The procedure typically lasts between 4 to 8 hours, depending on the complexity and size of the tissue defect.
Setting
This procedure is performed in a hospital operating room.
Personnel
- Surgical Team: Plastic or reconstructive surgeon, surgical assistants
- Anesthesiologist
- Operating Room Nurses
- Microsurgeon (for microvascular anastomosis)
Risks and Complications
- Infection
- Bleeding or hematoma formation
- Flap necrosis (failure of the tissue to survive)
- Blood clots
- Prolonged healing or wound complications
- Anesthetic complications
- Scarring
Benefits
- Effective reconstruction of complex tissue defects
- Improved wound healing and blood supply
- Restoration of function and aesthetic appearance
- Potential for a significant and lasting improvement in quality of life
Recovery
- Patients may need to stay in the hospital for several days post-surgery.
- Instructions will include wound care, activity restrictions, and pain management.
- Follow-up appointments will be necessary to monitor healing and flap viability.
- Most patients can return to normal activities in 4-6 weeks, though full recovery may take several months.
Alternatives
- Skin grafts
- Local flap (tissue moved within the same area)
- Artificial skin substitutes
- Negative pressure wound therapy
Pros and cons of alternatives depend on the specific clinical scenario; some may have shorter recovery times but might not offer the same level of functional or aesthetic benefit.
Patient Experience
- During the procedure, the patient will be under general anesthesia and will not feel anything.
- Postoperatively, there may be pain and discomfort, which can be managed with medications.
- Patients might experience swelling and bruising at both the donor and recipient sites.
- Regular follow-up visits are critical to ensure proper healing and function of the flap.
Pain management will be a priority, with medications and other comfort measures provided as needed.