The Omentum Free Tissue Transfer: A Compelling Option for Craniofacial and Cranial Base Reconstruction

Objective: Clinical outcomes in laparoscopically harvested omentum free flaps for cranial base and craniofacial reconstruction are presented in this paper, in the largest case series reported to date. We also present a comparative review of the surrounding literature.

Summary background data: Treatment of patients with craniofacial and cranial base tumors is a challenge due to the anatomic intricacies associated with the calvarium, the pathological diversity of lesions that present, and the potential complications.

Methods: A retrospective single-center experience for over 10 years with laparoscopically harvested omentum flaps used to reconstruct craniofacial and cranial base defects is presented.

Results: Fourteen patients underwent craniofacial or cranial base reconstruction using laparoscopically harvested omentum free flaps. The mean age for patients was 48. The anterior skull base represented the most common site of reconstruction with the omentum free flap. Thirteen of the grafts survived (93%), with one graft failure due to infection. All patients demonstrated satisfactory aesthetic and functional outcome. There were no peri-operative nor intra-abdominal complications.

Conclusions: The laparoscopically harvested omentum free flap is a safe and effective tool in the armamentarium of the reconstructive surgeon. It is the ideal option to treat complex, three-dimensional subcutaneous defects, such as those encountered in craniofacial and cranial base reconstruction. Its unique angiogenic and immunologic capacity make it an excellent flap for the previously irradiated and/or infected wound bed.