AUTOTRANSPLANTATION OF THE GREATER OMENTUM IN THE TREATMENT OF CHRONIC LYMPHEDEMA

Abstract

We evaluated the use of transplantation ofthe greater omentum in the management ofchronic lymphedema in 21 patients. Theomentum provides a large surface with fluidabsorbing capability and potentially thereforeis useful in management of patients withprimary or hypoplastic peripheral lymphatics.Based on the angio- and lymphangioarchitectureof the gastroepiploic architecture,we used large segments of greater omentum asa free autotransplant with microrevascularizationto the femoral or axillary artery andvein thereby avoiding technical drawbacks of apedicle graft with the feeding vessels traversingthe abdomen. Elongation of the omentum mustbe done properly because omental lymphaticarcades do not consistently follow the bloodvascular arcades in its more distal part.Accordingly, if not properly mobilized the bloodsupply may be retained whereas the lymphcirculation is interrupted. We combinedomental implantation with lymph nodal-venousanastomoses using an omental vein with anearby systemic venous tributary. In 19 of the21 patients followed from 3 months to 2 yearsafter operation, remission of lymphedema wasgood (reduction in swelling more than 50%) in14 patients and satisfactory in 5 (-25-50%reduction in swelling) with improvementgradually increasing with the passage of time.