EVALUATION OF THE GREATER OMENTUM IN THE TREATMENT OF EXPERIMENTAL LYMPHEDEMA

Abstract

Despite advances in microsurgery, the mostsuitable operation for primary lymphedemaremains unclear. A variety of tissue transplantsand artificial substances have been used tofacilitate drainage of peripheral lymph. Thegreater omentum, for example, has absorptivelymph draining capability, fights infection, andis expendable for the abdomen. Previousattempts to use the omentum in treatment ofclinical lymphedema have, however, beendisappointing. This discrepancy between theoryand outcome prompted us to reevaluate therole of the omentum in the treatment ofchronic lymphedema. In rabbits, mobilizationof omentum was carefully examined by threeseparate techniques and the presence ofnatural lymph nodal-venous (L-V) shuntsdetermined by an injection of Evans blue intothe omentum with sampling later of plasmafrom the gastroepiploic venous blood. In dogsafter promotion of unilateral chronic hindlimblymphedema by soft tissue excision andsclerosis, the results of four methods ofomental transplantation with or without L-Vshunt for relief of lymphedema were compared.The results in rabbits suggest that although thegreater omentum can be lengthened withoutjeopardizing its blood supply, it is inappropriateto lengthen it based on blood vascular arcadesalone because the omental lymphatics do notstrictly follow these arcades in the more distalportion, and with elongation, may beinterrupted even though the blood supplyremains intact. Moreover, because there is nonatural L-V shunt within the greateromentum, the addition of a L-V shunt in dogsin addition to omental transplantation seemsto increase effectiveness of the omentum fordraining hindlimb lymph after itsautotransplantation.