Preprocedural Planning

Infection and subsequent graft extrusion are the most common complications. Prevention requires thorough preoperative preparation, administration of antibiotics prophylaxis before the procedure, and strict maintenance of intraoperative sterility.

Equipment

The standard laparotomy set is required for omentoplasty; it includes the following:

Scalpel with No. 11 and No. 15 blades
Curved and straight artery forceps
A pair of toothed thumb forceps
A pair of nontoothed forceps
Allis forceps
Noncrushing intestinal clamps
Surgical cautery
Hemostatic clips or ligatures
Handheld ultrasonic dissector (if available)
Abdominal wall retractors or self-retaining retractors
Atraumatic visceral retractors
Suture materials (absorbable and nonabsorbable)
Anastomotic staplers

Patient Preparation

General anesthesia is preferred for this procedure. An epidural block may be added for postoperative pain management. After anesthesia induction, a 16- or 18-French Ryle tube is passed and kept on continuous drainage. The patient is then catheterized with a 14-French Foley catheter so that intraoperative and postoperative urine output can be monitored.

The patient is placed in a supine position, and preparation should include the whole of the abdomen, as well as the affected limb in which the omental transplant is planned.

Monitoring & Follow-up

Patients are assessed 7 days, 1 month, and 3 months after undergoing omentoplasty. The success of the procedure is evaluated both subjectively and objectively. The primary subjective criterion is symptomatic improvement. The main objective criteria include the following:

Improvement in the local skin temperature
Healing of ulcers and the amputation site
Improved oxygen saturation values on pulse oximetry

Technique

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Media Gallery

Omentoplasty. Omentum being mobilized.
Omentoplasty. Omentum being mobilized to reach below knee.
Omentoplasty. Skin incisions made on limb for subcutaneous tunneling of omentum.

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Omentoplasty Periprocedural Care

Preprocedural Planning

Equipment

Patient Preparation

Monitoring & Follow-up

References

Tables

Contributor Information and Disclosures

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