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The omental free flap and flow-through flap: pre-operative evaluation of right gastro-omental artery on multidetector computed tomography

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Abstract

Background

The gastro-omental artery (GOA) and the greater omentum are nowadays commonly used in many reconstructive surgeries, including cardiac, vascular, and plastic surgery. There are cases in which the GOA is found to be unsuitable only after partial harvesting following an upper laparotomy, and an improved method of pre-operative evaluation is required to eliminate the need for intraoperative small laparotomy.

Methods

Multidetector computed tomography was performed for 30 consecutive patients admitted for lower limb ischemia in a routine pre-operative evaluation of lower limb peripheral arterial disease (PAD). The origin of the GOA was checked on coronal and sagittal slices, its pathway was identified on the three-dimensional rendering. We assessed length and mean diameter of the distal and proximal right GOA, and the mean distances between the origins of GOA and the omental branches. Finally, we report one case of omental flow-through flap.

Results

30 patients were included in our study. Routine pre-operative MDCT during lower limb PAD workup enabled identification of GOA in all cases. The mean internal diameter of the GOA at its origin was 3.3 mm (± 3.3). The mean internal diameter of the distal GOA was 1.26 mm (± 0.3). At least one omental descending branch was detected in every case and in 63% (19 patients) at least two branches were visualized.

Conclusion

Routine pre-operative angio-MDCT imaging is an effective tool to assess precisely the different anatomical properties of the GOA. This exam could be useful for both diagnosis of lower limb PAD and evaluation of the GOA suitability for flow-through flap lower limb revascularisation.

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Authors and Affiliations

  1. Department of Vascular Surgery, Nancy University Hospital, University of Lorraine, 1, rue du Morvan, 54500, Vandoeuvre les Nancy, France

    Nicla Settembre, Zakariyae Bouziane & Sergueï Malikov

  2. INSERM 1116, University of Lorraine, Nancy, France

    Nicla Settembre & Sergueï Malikov

  3. Department of Radiology, Nancy University Hospital, University of Lorraine, Nancy, France

    Damien Mandry

  4. INSERM 947 (IADI), Nancy University Hospital, Nancy, France

    Damien Mandry & Marc Braun

  5. Department of Anatomy, Nancy University, University of Lorraine, Nancy, France

    Marc Braun

Authors
  1. Nicla Settembre
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  2. Zakariyae Bouziane
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  3. Damien Mandry
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  4. Marc Braun
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  5. Sergueï Malikov
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Contributions

Project development: NS, SM; Data collection: NS, SM; Data analysis: NS, SM, ZB, DM; Manuscript writing: NS, ZB, SM; Manuscript Revision NS, SM, MB, DM.

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Correspondence to Nicla Settembre.

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Settembre, N., Bouziane, Z., Mandry, D. et al. The omental free flap and flow-through flap: pre-operative evaluation of right gastro-omental artery on multidetector computed tomography. Abdom Radiol 45, 3321–3325 (2020). https://doi.org/10.1007/s00261-020-02493-8

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  • DOI: https://doi.org/10.1007/s00261-020-02493-8

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