Formation of independently revascularized small-bowel segments using pedicled omental flaps.

Abstract

This represents the initial report of intestinal revascularization with pedicled omental flaps producing bowel segments that are capable of surviving without their native mesenteric perfusion. In 10 mongrel dogs, a pedicled omental flap supplied by the left gastroepiploic arcade was sutured along a seromuscular incision in the antimesenteric border of an isolated 15-cm segment of proximal jejunum. After 5 weeks, to allow for revascularization, the mesenteric blood supply to each isolated segment was completely divided at its base. Total survival of all bowel segments occurred based solely on omental perfusion. With each animal serving as its own control, the capacity for absorption of D-xylose in isolated jejunal segments perfused only by an omental "neomesentery" was demonstrated to be equal to control jejunal segments perfused by their native mesenteries. Arteriographic evaluation of the revascularization process revealed that the omental "neomesentery" is capable of supplying the entire isolated bowel segment through anastomoses with the vascular channels already present in the bowel wall. The mechanism of the revascularization process was further explored and found to be intimately dependent on an intact marginal arterial arcade in the mesentery.