The major step toward successful tracheal transplantation is revascularization of the grafted trachea. There are many reports that although omentopexy is an effective method to facilitate neo-vascularization in tracheal transplantations, the procedure has not been accepted universally in the transplantation field. It remains unclear whether an omentopexy can successfully revascularize tracheal graft regardless of the length of graft. This study was undertaken to assess the usefulness of omentopexy for long-segment(more than 4 cm) tracheal allotransplantation. We have performed six tracheal transplantations with omentopexy (group A) and four tracheal transplantations without omentopexy (group B) in mongrel dogs from July 1993 to February 1995. Five mid-portion tracheal rings were removed from ten donor dogs and ten corresponding tracheal rings were removed from the ten recipient dogs. The excised tracheal rings from the donors were transplanted to the recipient tracheal-excised sites. All the recipients were given cyclosporine, azathioprine, and prednisolone for immunosuppression in the post-operative period. The histologic results of all the surviving members of group B were better than those of the group A. These findings indicate that omentopexy has a limitation, it is not a major method for graft revascularization. Therefore the length of the tracheal graft was greater than 4.0 cm, for its viability, a longer tracheal graft requires some other blood supply aside from the omentopexy.
Animal ; Dogs ; Omentum/*surgery ; Support, Non-U.S. Gov't ; Trachea/*transplantation ; Transplantation, Homologous

The present study was conducted to compare the effects of xenogenic bovine fetal demineralized bone matrix (DBM), commercial DBM, omentum, omentum-calf fetal DBM, cortical autograft and xenogenic cartilage powder on the healing of tibial defects in a dog model to determine the best material for bone healing. Seven male adult mongrel dogs, weighing 26.2 +/- 2.5 kg, were used in this study. Seven holes with a diameter of 4-mm were created and then filled with several biomaterials. Radiographs were taken postoperatively on day 1 and weeks 2, 4, 6, 8. The operated tibias were removed on the 56th postoperative day and histopathologically evaluated. On postoperative days 14, 42 and 56, the lesions of the control group were significantly inferior to those in the other group (p < 0.05). On the 28th postoperative day, the autograft group was significantly superior to the control and omentum groups (p < 0.05). Moreover, calf fetal DBM was significantly superior to the control group. There was no significant difference between the histopathological sections of all groups. Overall, the omentum and omentum-DBM groups were superior to the control group, but inferior to the autograft, commercial-DBM, calf fetal DBM and calf fetal cartilage groups.
Animals ; Autografts/*transplantation ; Biocompatible Materials/*therapeutic use ; *Bone Regeneration ; Cattle ; Dogs ; Male ; Omentum/*transplantation ; *Wound Healing

OBJECTIVETo study the efficacy of pedicled greater omentum transposed to mediastinum in prevention against postoperative in-hospital intrathoracic complications after esophagectomy.

METHODSClinical data of 148 consecutive patients with esophageal cancer undergoing Ivor-Lewis surgery in our department from January 2010 to May 2014 were retrospectively reviewed. Among them, 84 patients with omental transposition(transposition group) and 64 patients without omental transposition(non-transposition group) were compared.

RESULTSPostoperative hospital stay was shorter in patients with omental transposition compared to those without omental transposition(P<0.05). Intrathoracic infection rate was significantly lower in transposition group(33/84, 39.3%) than that in non-transposition group(36/64, 56.2%), and as was the combined sepsis rate[19/33, 57.6% vs. 31/36, 86.1%, P<0.05]. No significant differences were found in the morbidity of anastomotic leakage, wound infection, cardiac complication and mortality during hospitalization. The median postoperative hospital stay was significantly shorter in transposition group than that in non-transposition group(13.0 vs. 16.5 days, P<0.05).

CONCLUSIONOmental transposition to mediastinum can reduce the development and severity of intrathoracic infection and shorten hospital stay in patients undergoing esophagectomy.

Anastomotic Leak ; Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Humans ; Mediastinum ; surgery ; Omentum ; transplantation ; Postoperative Complications ; prevention & control ; Retrospective Studies

OBJECTIVETo evaluate the clinical efficacy of greater omentum in reconstruction of refractory wounds.

METHODSFrom August 1988 to May 2001, 20 patients with refractory wound underwent pedicle or microvascular free transfer of the greater omentum. Indications of surgery were electrical injury of the wrist and hand in 9 patients, electrical injury of the scalp and cranial bones in 3, avulsion injury of the scalp in 2, radiation-related ulcer of the chest wall in 2, ulcer and osteomyelitis following resection of the sternum sarcoma in 1, electrical injury of the abdomen in 1, bone and soft tissue defects following compound fracture of the leg in 1, and extensive scar and ulcer of the leg and footdrop following trauma in 1. Severe infection and extensive tissue necrosis were present prior to surgical operation in 12 patients. Eleven patients were treated with pedicled omental flaps, and 9 patients with free omental flaps. The size of the omental flaps ranged from 20 cm x 12 cm to 38 cm x 23 cm.

RESULTSAll the omental flaps survived. Healing at the first intention of the wounds was achieved in 17 cases. The on-top skin grafts resulted in partial necrosis of lipid liquefaction developed in the omentum and healed with dressing change in 2 cases. A sinus tract of osteomyelitis occurred in one case and healed after delayed excision of the necrosed bone. Follow-up study of all cases from 3 to 24 months showed no recurrent wounds and post-operative abdominal complication. Recovery with acceptable appearance and restoration of function was satisfactory.

CONCLUSIONSGreater omentum provides a well-vascularized tissue with lymphatic ducts for wound coverage. It has strong resistance against infection. It is very malleable and can be molded easily. Therefore it is an ideal tissue in filling cavities and repairing defects, especially in covering large and irregular defects that can not be treated with skin or muscle flaps.

Adolescent ; Adult ; Child ; Craniocerebral Trauma ; surgery ; Female ; Humans ; Male ; Middle Aged ; Omentum ; transplantation ; Surgical Flaps ; Treatment Outcome ; Wounds and Injuries ; surgery

Percutaneous transplant kidney biopsy has become the most important tool for diagnosing allograft dysfunction. However, renal biopsy has various complications. Among them, hemoperitoneum is a rare complication and has not been reported in Korea. We experienced a case of hemoperitoneum after transplant kidney biopsy. A 43-year-old man, 3 years after renal transplantation, was presented with elevated serum creatinine. Percutaneous renal biopsy was executed by real-time ultrasound guidance and 14-gauged spring loaded automated biopsy gun at upper pole of transplanted kidney. Renal biopsy was completed after 5 trials due to poor visualization of biopsy needle tip. After 2 hours, the patient complained of acute right side abdominal pain and dizziness. Abdominal pelvis CT showed moderate amount of hemoperitoneum. The patient underwent emergency laparotomy. Hematoma was seen in the omentum with minor vessel bleeding. Ligation was done. The patient was discharged after 15 days.
Abdominal Pain ; Adult ; Biopsy ; Creatinine ; Dizziness ; Emergencies ; Glycosaminoglycans ; Hematoma ; Hemoperitoneum ; Hemorrhage ; Humans ; Kidney ; Kidney Transplantation ; Korea ; Laparotomy ; Ligation ; Needles ; Omentum ; Pelvis ; Transplantation, Homologous ; Transplants

OBJECTIVETo explore novel methods of possible donor organ supply and immunologic tolerance induction of organ transplantation.

METHODSWhole metanephroi from d14-19 (E14-E19) embryos of pregnant rats were grouped and allografted into the omenta or near remnants of renal vessels of nonimmunosupressed adult rats. At the time of implantation, host rats underwent unilateral nephrectomy. Four weeks after implantation, allografted metanephroi in host rats were removed for gross, biochemical and histopathological examination.

RESULTFour weeks post-implantation, (1) E19 and E18 metanephroi had enlarged,but were replaced by connective tissues. (2) E17 and E16 metanephroi showed the signs of acute rejection such as hypercellular glomeruli and lymphocyte infiltration in peritubular spaces. E16 grafted metanephroi underwent mild acute rejection of Banff schema, while E17 had moderate or severe acute rejection. When Cyclosporine A was administrated, E17 metanephroi formed mature nephrons and collecting ducts with few lymphocyte infiltration. (3) Metanephroi from E15 and E14 embryos allografted into the omentum or near remnants of renal vessels of uninephrectomized adult rats were enlarged and vascularized, and formed mature tubules and glomeruli. (4) The concentrations of urea nitrogen and creatinine in cyst fluid of E15 and E16 metanephroi were increased 40-fold and 50-fold, which were comparable to those in bladder urine. (5) In contrast, rat metanephroi did not grow or differentiate in rats without host kidney resection.

CONCLUSIONE14 and E15 metanephroi allografted into nonimmunosuppressed adult rats or E17 into cyclosporine-treated hosts undergo growth and differentiation and become vascularized. A variety of factors affect the growth and development of allografted metanephroi, while rejection is the main one.

Animals ; Embryo, Mammalian ; Female ; Fetal Tissue Transplantation ; Graft Survival ; Kidney ; embryology ; Kidney Transplantation ; Male ; Omentum ; surgery ; Organogenesis ; Rats ; Rats, Sprague-Dawley

BACKGROUND: Pleura, diaphragm, pericardial fat pad, intercostal muscles and omentum can be used to protect and revascularize the bronchial suture line of tracheal transplantation, lung transplantation and pulmonary resection. The purpose of the present study is to compare the influence of the pleura, diaphragm and omentum in survival of isolated tracheal segments in the experimental animals. MATERIAL AND METHOD: Sprague-Dawley rats weighing 250~350 g were used. The animals were divided in three groups; the pleura, omentum and diaphragm. Following intraperitoneal anesthesia, endotracheal intubation was performed. Then the trachea was exposed. A three-ring section of cervical trachea was excised. The resected trachea was implanted at each sites. After 2 weeks, rats were sacrificed. Histopathological examination of the tracheal segments was performed. For comparison of each groups, histopathological viability of resected tracheal segment was scored by three tissue layers; epithelium, submucosa, and cartilage. The results were presented as average score. RESULT: In histopathological examination, submucosa and cartilage using tracheal segment necrosis scoring system. The pleural group showed well preserved tissue. There was minimal necrosis and inflammation compared with other groups. In the pleural group, tracheal necrosis scores were 2.17+/-0.983 at epithelium, 1.67+/-0.516 at submucosa and 2.17+/-0.753 at cartilage. At the omental group, scores were 1.00+/-0.00, 1.60+/-0.548 and 1.80+/-0.447. In the diaphragmatic group, scores were 1.40+/-0.894, 2.40+/-0.547 and 2.20+/-0.447. Total necrosis score were 6.00+/-1.789 in the pleural group, 4.40+/-0.894 in the omental group and 6.00+/-1.414 in the diaphragmatic group. CONCLUSION: There were no significant viability differences in terms of total necrosis score for the viability of resected tracheal segment. But the best result was achieved in the omental group. Therefore, omental wrapping on tracheal graft site will be beneficial for the prevention of graft necrosis.
Adipose Tissue ; Anesthesia ; Animals ; Autografts* ; Cartilage ; Diaphragm* ; Epithelium ; Graft Survival ; Inflammation ; Intercostal Muscles ; Intubation, Intratracheal ; Lung Transplantation ; Necrosis ; Omentum* ; Pleura* ; Rats ; Rats, Sprague-Dawley ; Sutures ; Trachea ; Transplants

OBJECTIVETo report our primary experience with immediate breast reconstruction using laparoscopically harvested omental flap after breast-conserving surgery. The safety, feasibility, and clinical effect are also evaluated.

METHODSFrom Jun. 2010 to Jan. 2011, 5 cases who underwent immediate breast reconstruction using laparoscopically harvested omental flap after breast-conserving surgery were retrospectively analyzed. The operative duration, postoperative days in hospital, complication and therapeutic effect were reviewed.

RESULTSAll the patients were treated successfully without laparotomy. The average operative duration was 310 min, including 60 min for harvesting the omental flap. The median postoperative days in hospital was 8 days (ranged, 5-9 days). One case complained of slight pulled feeling in upper abdomen. No other complication happened. The cosmetic result of reconstructed breasts was satisfactory.

CONCLUSIONSThe immediate breast reconstruction using laparoscopically harvested omental flap is safe and feasible with less morbidity in donor sites and good cosmetic effect. It is one of the ideal methods for immediate breast reconstruction.

Adult ; Breast Neoplasms ; surgery ; Female ; Humans ; Laparoscopy ; Mammaplasty ; methods ; Mastectomy, Segmental ; Middle Aged ; Omentum ; transplantation ; Postoperative Period ; Retrospective Studies ; Surgical Flaps ; Treatment Outcome

Although the liver is the most common site for pancreatic islet transplantation, it is not optimal. We compared kidney, liver, muscle, and omentum as transplantation sites with regard to operative feasibility, and the efficiency of implantation and glycemic control. Islets from C57BL/6 mice were transplanted into diabetic syngeneic recipients. The mean operative time and mortality were measured to assess feasibility. To assess implantation efficiency, the marginal mass required to cure diabetes and the mean time taken to achieve normoglycemia were measured. A glucose tolerance test was performed to assess glycemic control efficiency. The data are listed in the order of the kidney, liver, muscle, and omentum, respectively. The mean mortality rate was 6.7, 20.0, 7.1, and 12.5%; the mean operative time was 10.2, 27.4, 11.2, and 19.8 min; the marginal islet mass was 100, 600, 600, and 200 islet equivalence units and the mean time to reach euglycemia was 3.0, 15.1, 26.6, and 13.9 days. The glucose kinetics of omental pouch islets was the most similar to controls. Thus, a strategic approach is required for deciding on the best transplantation recipient sites after considering donor sources and islet volume. Alternatives can be chosen based on safety or efficacy.
Animals ; Blood Glucose/analysis ; Diabetes Mellitus, Experimental/chemically induced/mortality ; Glucose Tolerance Test ; Hyperglycemia/therapy ; *Islets of Langerhans Transplantation ; Kidney ; Liver ; Mice ; Mice, Inbred C57BL ; Muscle, Skeletal ; Omentum ; *Transplantation, Heterotopic

A liver originating from Maastricht category 4 non-heart-beating donor (NHBD: cardiac death in a brain death donor) was procured and transplanted. Donor was 46 years old female. She was moved to the operation room after 3 times of cardiopulmonary resuscitation. Arrest occurred 15 minutes after stopping ventilation. After 5 min waiting time, the incision was performed. The interval between incision and initiation of donor perfusion was 5 minutes. Warm ischemic time, which is from the withdrawal of support to perfusion, was 25 minutes. Super-rapid technique was used for the donor procedure. The frozen biopsy of the liver was performed before transplantation and macrovesicular and microvesicular fatty change were less than 5% respectively. The cold ischemic time was 6 hours 22 minutes. Orthotopic liver transplantation was performed with the preservation of the recipient caval vein without venovenous bypass. The recipient was 56 years old female. She suffered from cryptogenic liver cirrhosis with refractory ascites. Postoperatively, the early graft function was good. At the post-operative 10th day, Serum total bilirubin was 1.4 mg/dL and aspartic acid transaminase and alanine aminotransferase was 26 IU/L and 20 IU/L respectively. Post operative 10th day liver biopsy was normal. She stayed at the intensive care unit for 6 days. Post-operatively, Tuberculosis (Tb) peritonitis (by the intra-operative omentum tissue culture) was diagnosed and the patient is under Tb medication. This experience suggests that careful donor selection, minimizing warm and cold ischemic time and utilization of histology provide acceptable results of liver transplantation from NHBD.
Alanine Transaminase ; Ascites ; Aspartic Acid ; Bilirubin ; Biopsy ; Brain Death ; Cardiopulmonary Resuscitation ; Cold Ischemia ; Death ; Donor Selection ; Female ; Humans ; Intensive Care Units ; Liver ; Liver Cirrhosis ; Liver Transplantation ; Omentum ; Perfusion ; Peritonitis ; Tissue Donors ; Transplants ; Tuberculosis ; Veins ; Ventilation ; Warm Ischemia