Utilization of a composite island flap employing omentum in organ reconstruction: an experimental investigation

New methods for the reconstruction of the ear, nose, and breast using omentum to vascularize appropriate tissue composites of skin, bone, and cartilage are described. The initial investigation demonstrated that it is possible to obtain an island composite flap with omentum-costal cartilage-skin flap and preserve cartilage viability inside the omentum. The ear and nose were reconstructed in two stages. In the first stage, the appropriately carved cartilage and/or bony framework was covered with omentum and a skin graft, leaving the tissue composite buried subcutaneously. In the second stage, the newly reconstructed organ was exteriorized and diagnostic studies were done. The breast reconstruction was undertaken in two stages, first creating an omental island skin flap and subsequently either implanting a standard prosthesis under the flap or transferring the entire composite superiorly to better simulate the clinical reconstruction wherein the lower abdominal skin with omentum would be moved to the anterior chest. In each reconstruction a variety of diagnostic studies, including intravenous fluorescein dye, radioactive isotope uptake, and microangiography, were performed.