Salvage treatment of an irradiated, infected lumbosacral wound

A 60-year-old male with lumbosacral multiple myeloma received 5100 cGy of external-beam radiation, thalidomide, and Decadron. He subsequently underwent excision of the epidural tumor, decompressive L4, L5, and S1 laminectomies, and bilateral L4-5 and L5-S1 medial facetectomies. The patient developed osteoradionecrosis, cerebrospinal fluid leak, wound infection, and sepsis. Debridement and bilateral V-Y fasciocutaneous advancement flaps failed. Pedicled omental transposition flap through a Petit triangle tunnel was successfully performed. Omental transposition provides a safe option for salvage treatment of irradiated, infected lumbosacral wounds. The plastic and trophic qualities of the omentum make it an excellent choice to fill poorly vascularized wounds. In addition to its immunologic and neoangiogenic properties, the omentum has a dense lymphatic network with tremendous absorptive potential. Its biologic advantages must be weighed against the need for celiotomy and available local options according to circumstances.