Omental Flap to Non-healing Posterior Trunk Wound: A Case Report

Abstract

Large posterior trunk wounds often require flap reconstruction. One option for posterior truncal reconstruction not readily considered, often due to the combined anterior and posterior approaches required for harvesting and coverage, is the omental flap; however, the omental flap stands as a robust backup in non-healing wounds when local flap options have been exhausted. We present a case of a posterior trunk wound that had previously undergone multiple unsuccessful local and regional flaps for reconstruction and was ultimately treated with a pedicled omental flap which went on to heal without any post-operative complications.

Keywords: back reconstruction; chronic back wound reconstruction; omental flap; posterior chest wall reconstruction; posterior trunk reconstruction.

Figure 1. Left lower back wound showing previous incision and the chronic draining sinus in the incision. The purple marks where the mental flap was tunneled posteriorly.

Figure 2. Omental flap harvest from the anterior approach showing the mental flap still attached to the left gastroepiploic vessels.

Figure 3. Omental flap transposed through retroperitoneum and brought out posteriorly into the chronic wound after the wound was debrided of all necrotic and radiated tissues.

Figure 4. Omental flap was then draped and laid out into the wound to provide an obliteration of the dead space as well as bring in the healthy, vascularized tissue to the wound.

Figure 5. Final closure after the sinus track and the necrotic/radiated tissue was excised and the mental flap was draped into the wound. A JP drain was placed into the wound and the overlying skin flaps were brought together there and closed.