SIMULTANEOUS RECONSTRUCTION OF EXTENSIVE SOFT-TISSUE DEFECTS OF BOTH LOWER-LIMBS WITH FREE HEMIFLAPS HARVESTED FROM THE OMENTUM

Simultaneous resurfacing of extensive soft-tissue defects involving bo th lower extremities can be performed successfully with free hemiflaps harvested from the omentum. This avoids the need for staged operation s or for separate donor sites with the concomitant morbidities, the po ssible need for intraoperative repositioning, and the significantly gr eater operative time. During the past 3 years, six omental free hemifl aps were performed in three patients for bilateral lower limb reconstr uction. All patients had extensive ulcerations, averaging 207.5 cm(2) in surface area. Ulcerations were secondary to either homozygous sickl e cell anemia (two patients) or chronic venous insufficiency (one pati ent). Operative time averaged 11 hours for the bilateral procedures. D elayed skin grafting was performed in two patients. All six omental fr ee 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 compl ications. Free hemiflaps harvested from the omentum can provide suffic ient well-vascularized tissue with large-caliber vessels for coverage of separate extensive soft-tissue defects in one operation with minima l donor-site morbidity, making this an ideal flap option when multiple sites are involved.