A new composite gastric seromuscular and omental pedicle flap

Ann Surg. 1994 Jul;220(1):97-101. doi: 10.1097/00000658-199407000-00014.

Abstract

Objective: The authors performed a study to see if gastric seromuscular patch elevation is anatomically feasible and to estimate the maximum size of the patch relative to its blood supply.

Summary background data: A flap composed of greater omentum and a full-thickness segment of the greater curvature of the stomach, based on the right gastroepiploic artery, was first described in 1977. Elevation of the greater omentum along with a seromuscular patch of stomach has not been reported previously.

Methods: Angiography was performed via the right gastroepiploic artery in a stomach obtained from ten patients who underwent gastrectomy, then india ink was injected. The stomach was then fixed in 10% formalin, and histochemical examination was performed to determine if seromuscular patch elevation was possible.

Result: Results of the angiography and injection experiment of india ink indicated that the territory of a single gastric ramus was approximately 5 cm x 5 cm in both anterior and posterior walls of the stomach. Histology revealed that the gastric rami lay between the muscular layer and the mucosa.

Conclusion: The authors believed that a composite gastric seromuscular patch and omental pedicle flap would be clinically applicable. The authors also believed that the maximum size of the patch was 10 cm x 10 cm. They used this flap to successfully treat three patients with chronic soft-tissue defects--two bronchopleural fistulae and a radiation ulcer.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Bronchial Fistula / etiology
  • Bronchial Fistula / surgery
  • Female
  • Fistula / etiology
  • Fistula / surgery*
  • Humans
  • Male
  • Middle Aged
  • Omentum / transplantation
  • Pleural Diseases / etiology
  • Pleural Diseases / surgery*
  • Postoperative Complications / etiology
  • Postoperative Complications / surgery*
  • Radiation Injuries / etiology
  • Radiation Injuries / surgery*
  • Skin Ulcer / etiology
  • Skin Ulcer / surgery*
  • Stomach / transplantation
  • Surgical Flaps / methods*