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Page 4 of 6 Moores et al. Plast Aesthet Res 2018;5:44 I http://dx.doi.org/10.20517/2347-9264.2018.32

A B

Figure 3. A: bleeding and viable tunneled omentum providing circumferential coverage of in-line cryo-vein reconstruction; B: six-month
follow-up with healed surgical wounds

Figure 4. Pre-operative (upper) and post-operative (lower) CT images. Pre-operatively an impressive phlegmon with diffuse gaseous
infiltration and mass-effect. Post-operatively the inflammation has resolved, and the graft is seen circumferentially enclosed in an
omental sheath

operative groin these options may have already been exhausted the rectus abdominus may also be used, but
in our patient the deep inferior epigastric artery (DIEA) had been stented across at the time of secondary
pseudoaneurysm repair and was therefore not an option.

In our patient there were little to no options for pedicled reconstruction. In considering free flap
reconstruction we evaluated the free ALT and latissimus dorsi, however we preferred to avoid protracted
operative time in this multiply comorbid and multiply re-operative patient who had undergone a long ICU
course including iliac and femoral vein DVT in the affected extremity.

[7]
Omental flaps are well described for chest wall reconstruction based on the right gastroepiploic artery . The
omentum functions as a physical and immunologic barrier in the abdomen in its native position, and for
[3,5]
this reason it is a favorite of general and urologic surgeons for covering anastomoses .
As a pedicled flap for extra-abdominal and extra-thoracic wound coverage, the omentum is less well
documented. In our case the omentum provided an excellent source of circumferential coverage for an inline
vascular graft under the inguinal ligament and was delicate enough not to compress a cryo-vein conduit.
Additionally, the remaining transposed omentum filled much of the dead space in the large groin wound.

Regarding the reach of the pedicled omental flap, there is little documentation. The size and length of the
omentum differs between people widely. Slender people tend to have less robust omentum, however, it is not