Simultaneous reconstruction of extensive soft-tissue defects of both lower limbs with free hemiflaps harvested from...

Simultaneous resurfacing of extensive soft-tissue defects involving both lower extremities can be performed successfully with free hemiflaps harvested from the omentum. This avoids the need for staged operations or for separate donor sites with the concomitant morbidities, the possible need for intraoperative repositioning, and the significantly greater operative time. During the past 3 years, six omental free hemiflaps were performed in three patients for bilateral lower limb reconstruction. All patients had extensive ulcerations, averaging 207.5 cm2 in surface area. Ulcerations were secondary to either homozygous sickle cell anemia (two patients) or chronic venous insufficiency (one patient). Operative time averaged 11 hours for the bilateral procedures. Delayed skin grafting was performed in two patients. All six omental free hemiflaps were successful. Partial skin-graft loss due to infection occurred in both sickle cell anemia patients. Significant improvement in symptoms was noted in all patients. There were no donor-site complications. Free hemiflaps harvested from the omentum can provide sufficient well-vascularized tissue with large-caliber vessels for coverage of separate extensive soft-tissue defects in one operation with minimal donor-site morbidity, making this an ideal flap option when multiple sites are involved.