Role of omental flaps in thoracic surgery complications: a narrative review

The greater omentum is a highly vascularized and immunologically active organ with recognized regenerative and antimicrobial properties. Its application in pleural space complications has gained renewed interest with the expansion of minimally invasive harvesting techniques. This review summarizes the current literature regarding the role of omental flaps in the management of post-lobectomy complications.

This narrative review was conducted using a comprehensive search of MEDLINE (Via PubMed), Scopus, and Cochrane Central Register of Controlled Trials from database inception through February 2026 using the search terms "Omental flap", "pleural space", and "bronchopleural fistula", "post-lobectomy complications", "entrapped lung" and "empyema". Peer-reviewed articles in English and Spanish were included. Data were extracted and synthesized narratively, focusing on indications, techniques, outcomes, advantages, and limitations.

Omental flaps are most used for bronchopleural fistula (BPF), empyema, mediastinitis, and prosthetic graft coverage. Rich vascular and lymphatic networks of the omentum enhance infection control and tissue healing, particularly in contaminated or high-risk fields. The size and pliability of the omentum allow effective obliteration of complex pleural dead space problems and durable coverage of critical structures. Reported flap survival rates range from 80-100% in small case series.

Omental flaps represent a versatile and biologically advantageous option for pleural space complications. Although current evidence is limited and largely observational, reported outcomes are promising, warranting further prospective investigation.