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:
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Scalpel with No. 11 and No. 15 blades
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Curved and straight artery forceps
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A pair of toothed thumb forceps
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A pair of nontoothed forceps
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Allis forceps
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Noncrushing intestinal clamps
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Surgical cautery
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Hemostatic clips or ligatures
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Handheld ultrasonic dissector (if available)
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Abdominal wall retractors or self-retaining retractors
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Atraumatic visceral retractors
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Suture materials (absorbable and nonabsorbable)
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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:
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Improvement in the local skin temperature
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Healing of ulcers and the amputation site
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Improved oxygen saturation values on pulse oximetry
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Omentoplasty. Omentum being mobilized.
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Omentoplasty. Omentum being mobilized to reach below knee.
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Omentoplasty. Skin incisions made on limb for subcutaneous tunneling of omentum.
