Surgical and applied anatomy of the omentum. Basis for its medical and surgical use

Abstract

The epiploic apron is habitually used by the organism to block abdominal infectious processes, and inclusively it has been used by surgeons to cover bloody surgical zones (vascular bed of cholecystectomy, postappendectomy, etc.); for that reason it has been called “abdominal police”. This roll is fulfilled thanks to the presence of a bactericidal factor and of an angiogenic factor, discovered by Goldsmith and Silvermann, who in experimental models, where they performed aortic prosthetic interpositions (dacron), developing retroperitoneal abscesses, demonstrated both “factors”. From this concept we have used a flap from the epiploic apron to cover infected arterial prosthesis and although the prosthetic infection is a nonfrequent complication, it served to avoid the prosthesis extraction and the consequent amputation of the member. This work intended to meticulously study the fascial anatomy of the epiploic apron and its vascularization, with the purpose of obtaining an apron pedicle capable of being mobilized surgically, as it is specified in the work. Fifty-six cases, including 20 anatomical and fetal dissections and 36 surgical cases, were used. From the analysis of the results it has been possible to elaborate a four- type classification of the arterial vascular epiplon, two of which are apt to develop a pedicle and comprise more than 80% of the cases under analysis. In addition, cases in which the pedicle flap has been used are presented.

Key words: applied anatomy, epiplons, vascular pedicle.