[Application of pedicled omentum flap in breast reconstruction of breast cancer patients].

OBJECTIVE: To explore the clinical application of the pedicled omentum flap in breast reconstruction of breast cancer patients. METHODS: Between May 2013 and October 2017, 205 patients with breast cancer received modified mastectomy. The pedicled omentum flap was used to reconstruct breast at the same time. All patients were female with an average age of 34.9 years (mean, 26-58 years). The tumor located at left breast in 127 cases and right side in 78 cases. The diameter of the tumor was 2-5 cm (mean, 2.9 cm). The 120 cases of breast cancer were at stage Ⅰ and 85 cases were at stage Ⅱ; and 126 cases were invasive ductal carcinoma and 79 cases were invasive lobular carcinoma. The course of disease ranged from 10 to 92 days (mean, 38.5 days). The size of defect after tumor ablation ranged from 9 cm× 6 cm to 18 cm×12 cm; the size of pedicled omentum flap ranged from 18 cm×10 cm to 22 cm×16 cm. RESULTS: According to the anatomical basis, the omentum was divided into 4 types, including thin type (42 cases, 20.5%), medium type (133 cases, 64.9%), hypertrophy type (24 cases, 11.7%), and absence type (6 cases, 2.9%). All omentum flaps survived successfully and the incisions healed by first intention. All patients were followed up 6-74 months (mean, 24.5 months); 83 cases were followed up more than 5 years. The shape, texture, and elasticity of the reconstructed breast were good and no flap contracture deformation happened. Only linear scar left at the donor sites, and the function of abdomen was not affected. No local recurrence happened. CONCLUSION: The pedicled omentum flap can be harvested safely and reliable, which is the one of ideal option for breast reconstruction in breast cancer patients.

Three-dimensional visualization technique in endoscopic breast-conserving surgery and pedicled omentum for immediate breast reconstruction.

PURPOSE: To evaluate the three-dimensional visualization technique (3DVT) in endoscopic breast-conserving surgery (EBCS) and pedicled omentum for immediate breast reconstruction. METHODS: Clinical data of 256-slice multi-detector CT scanning from 52 patients (group A) were introduced into self-developed Medical Imaging 3D Visualization Systems (MI-3DVS) for individualized segmentation, 3D reconstruction and volume calculation. The surgical process was designed according to the 3D model. Next, the EBCS and pedicled omentum breast reconstruction were performed according to the preoperative design. Finally, the operating time, blood loss, length of postoperative hospital stay, complications and cosmetic outcomes in group A were compared to 44 patients in group B, who underwent the same operation without 3DVT. RESULTS: The 3DVT can be used to analyze the location of the breast tumors and determine the excision extension of the breast precisely. Compared to group B, group A had the advantage of less bleeding, shortened operating time and earlier discharge (p < 0.05). The cosmetic results of group A were more satisfactory than those of group B (p < 0.05). After a postoperative follow-up of 6-30 months, none of the patients in either group showed any signs of recurrence. CONCLUSIONS: 3DVT can be used to design the surgical process preoperatively and results in positive therapeutic and cosmetic outcomes in EBCS and pedicled omentum for immediate breast reconstruction.

Application of pedicled omentum flap in breast reconstruction of breast cancer patients / 中国修复重建外科杂志

Objective: To explore the clinical application of the pedicled omentum flap in breast reconstruction of breast cancer patients. Methods: Between May 2013 and October 2017, 205 patients with breast cancer received modified mastectomy. The pedicled omentum flap was used to reconstruct breast at the same time. All patients were female with an average age of 34.9 years (mean, 26-58 years). The tumor located at left breast in 127 cases and right side in 78 cases. The diameter of the tumor was 2-5 cm (mean, 2.9 cm). The 120 cases of breast cancer were at stage Ⅰ and 85 cases were at stage Ⅱ; and 126 cases were invasive ductal carcinoma and 79 cases were invasive lobular carcinoma. The course of disease ranged from 10 to 92 days (mean, 38.5 days). The size of defect after tumor ablation ranged from 9 cm× 6 cm to 18 cm×12 cm; the size of pedicled omentum flap ranged from 18 cm×10 cm to 22 cm×16 cm. Results: According to the anatomical basis, the omentum was divided into 4 types, including thin type (42 cases, 20.5%), medium type (133 cases, 64.9%), hypertrophy type (24 cases, 11.7%), and absence type (6 cases, 2.9%). All omentum flaps survived successfully and the incisions healed by first intention. All patients were followed up 6-74 months (mean, 24.5 months); 83 cases were followed up more than 5 years. The shape, texture, and elasticity of the reconstructed breast were good and no flap contracture deformation happened. Only linear scar left at the donor sites, and the function of abdomen was not affected. No local recurrence happened. Conclusion: The pedicled omentum flap can be harvested safely and reliable, which is the one of ideal option for breast reconstruction in breast cancer patients.

The value of improved jejunostomy in operation for patients with esophageal carcinoma / 临床外科杂志

Objective To explore the safety and feasibility of improved jejunostomy in operation for patients with esophageal carcinoma.Methods All these 214 patients underwent resections of esophageal carcinoma and jejunostomy were divided into 2 groups,130 patients in routine group and 84 patients in improved group.A 1.5 to 2.0 centimeter in width pedicled omentum were left during dissociating the stomach for patients of improved group.Double purse-string suture were left on the prepared jejunostomy.Pedicled omentum was placed around jejunum tube which was fixed by double suture to peritoneum.Then the operating time,discharging time,leakage,infections,tube shedding and intestinal obstruction were analysed.Results All patients in both groups were healed.There's a statistically significant difference(P0.05)in discharging time,leakage,infections and tube shedding.Conclusion Improved jejunostomy can reduce the operating time,and it's a safe and feasible way in jejunum tube placement.

Preventing and localizing esophagogastric anastomosis leakage by sleeve-wrapping of the pedicled omentum.

AIM: To develop a technique of sleeve-wrapping the pedicled omentum around the esophagogastric anastomosis for preventing and localizing leakage. METHODS: This study includes data from 86 patients who were diagnosed with esophageal cancer and underwent the technique of sleeve-wrapping the pedicled omentum around esophagogastric anastomosis after esophagectomy between November 2011 and July 2013. The early complications that occurred during follow-up were analyzed. RESULTS: Postoperative complications included pulmonary complications (13/86; 15.1%) and abdominal or thoracic wound infection (3/86; 3.5%). Complications that occurred during follow-up included one case of anastomosis leakage (limited by omentum; 1.2%) and five case of anastomosis stricture (5.8%). No deaths occurred. All complications were resolved through traditional treatment. No additional surgery was needed. CONCLUSION: Sleeve-wrapping of the pedicled omentum around esophagogastric anastomosis after esophagectomy is safe and effective for preventing and localizing anastomosis leakage without increasing anastomosis stricture.

Clinical effects of pedicled omentum covering the intestinal anastomotic stoma in preventing anastomotic fistula / 中华消化外科杂志

Objective To investigate the clinical effects of pedicled omentum covering the intestinal anastomotic stoma in preventing anastomotic fistula.Methods The clinical data of 133 patients with high risk of intestinal anastomotic stoma who were admitted to the Henan Tumor Hospital from May 2009 to May 2012 were retrospectively analyzed.All patients were divided into the improvement group (69 patients) and the control group (64 patients) according to whether the anastomotic stoma was covered by pedicled omentum.All the operations were done by the surgeons in the same group,and the intestinal reconstruction was done by the equipment produced by the same company.All the patients with intestinal tumors received radical resection.The clinical data of the patients in the 2 groups were reviewed and the therapeutic effects of the 2 approaches were compared.All data were analyzed using the chi-square test.Results Three (4.3％) patients had intestinal fistula in the improvement group,including 1 had small bowel anastomotic fistula,1 had small bowel and colonic anastomotic fistula,1 had colonic anastomotic fistula.Eight (12.5％) patients in the control group had intestinal anastomotic fistula,including 1 had duodenal anastomotic fistula,2 had small bowel anastomotic fistula,2 had small bowel and colonic anastomotic fistula,and 3 had colonic anastomotic fistula.There was a significant difference in the incidence of anastomotic fistula between the 2 groups (x2 =5.483,P ＜ 0.05).The highest body temperatures of the 3 patients in the improvement group were under 38.2 ℃,and the mean white blood cell count was 8.4 × 109/L;no peritonitis was detected; turbid drainage was observed in the peritoneal tube around the anastomotic stoma.The results of computed tomography showed local inflammation.The highest body temperatures of the 8 patients in the control group were above 38.5 ℃,and the mean white blood cell count was 14.4 × 109/L; obvious pressing pain and rebound tenderness were detected; intestinal contents were observed in the peritoneal drainage tube.The 3 patients in the improvement group were cured by symptomatic treatment.Of the 8 patients in the control group,7 received two-stage debridement,and 1 received jejunostomy and 3 received ileostomy.The condition of the 7 patients was recovered after operation,and reversion of the ileum at postoperative month 4.One patient died of multiple organs dysfunction syndrome and systemic inflammatory response syndrome.Conclusion Intestinal anastomotic stoma covered by pedicled omentum could effectively decrease the incidence of anastomotic fistula and alleviate systemic inflammatory response syndrome caused by anastomotic fistula.

Repairing effect of pedicle omentum in severe ureteral injury / 中华泌尿外科杂志

Objective To evaluate the repairing effect of pedicle omentum on severe ureteral in-jury. Methods Twenty healthy dogs were randomized into the experiment group and the control group. Firstly the model of severe ureteral injury was made. In experimental group, the pedicle omen-turn were used to wrap up the severe injured ureter, but which was no done in control group. Urinary fistula and ureteral necrosis were observed. At 12 weeks postoperatively,the models were re-operated to investigate whether the severe injured ureters had healed. Angiogenesis, VEGF and its receptor KDR were also examined in stoma and surrounding tissue histopathologically. Results No urinary fistula was observed in experimental group, but 2 cases in control group were dead because of recurrent abdominal cavity infection after the formation of urinary fistula. The mucosa and smooth muscle of stoma were completely regenerated, and the blood vessels were regenerated more significantly in expe-rimental group than in the control group. In experimental group, the VEGF and KDR were over-ex-pressed, and the positive cell rates were (12. 65±0. 02)% and (10. 23±0. 03)%. But in control group, the stoma were not healed, and severe ureters1 strictures were observed in all dogs. Angiogene-sis was not signifieant, the VEGF and KDR positive cell rates were (1.54±0. 03)% and (2. 654± 0.04)%, respectively. Conelusions Pedicled omentum can promote the repair of severe ureteral in-jury. The mechanism may be the over expression of VEGF and KDR in prompting angiogenesis.