Online Atlas of Microsurgery

An atlas of microsurgery techniques and principles.

The Greater Omentum

Greater Omentum Flap

Anatomic considerations

Fat, connective tissue and lymphatics. The omentum is known as the policeman of the abdomen for its role in fighting intra-abdominal infection.
this flap is not innervated.
Blood supply:
The right omental artery via the right gastroepiploic artery.
A large caliber vessel at least 2 to 3 millimeters in size.
Vein: The corresponding vein is large, comparable or larger in size than the arter.
Pedicle length:
Can be dissected into the flap to increase pedicle length to at least 4 or 5 centimeters.

In 1972 Harry Buncke and Donald McLean published results of the first successful clinical microsurgical transplant. They used the greater omentum to cover a large scalp defect with exposed cranial bone resulting from a post-traumatic defect. This achievement was built upon laboratory research in microsurgery, using one of the first operating diploscopes in the United States, and microsurgical suture that was created by directly bonding nylon on a handmade needle.

The greater omentum is a large peritoneal fold consisting of connective tissue, fat and lymphatics.  It is well vascularized with large feeding arteries and draining veins.  Because harvesting requires laparotomy, this flap is used infrequently.  Previous abdominal surgery may render the omentum scarred and adherent to the intra-abdominal contents, and therefore preclude its use.

Vascular Anatomy

The omentum possesses a rich arterial arcade with three dominant vessels descending from the gastroepiploic artery, along the greater curvature of the stomach.  A right, middle and left omental branch arise from gastroepiplic system, with smaller intervening branches and adjacent draining veins. The flap is isolated on the right omental artery and the right gastroepiploic artery.

The Vascular Anatomy of the Omentum

The greater omentum is supplied by three main arterial branches: the right, middle and left omental arteries. These take origin from the gastroepiploics.

Operative Procedure

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