Laparoscopically Harvested Omental Free Flap for Skull Base Reconstruction

Objective: To describe the first series of patients having undergone laparoscopic harvesting of free omental tissue for microvascular reconstruction of the skull base and facial soft tissues. Methods and Materials: Retrospective chart review of the initial nine patients who underwent laparoscopic harvesting of omentum for microvascular transfer to the skull base and face. Patient demographics, indications for the procedure, laparoscopic technique, site of reconstruction, postoperative skull base and abdominal complications, and overall flap survival, and a comparison to omental harvesting via laparotomy and to other types of microvascular flaps, are described. Results: Six men and three women underwent laparoscopic harvesting of free omentum for microvascular transfer. Four patients had reconstruction of anterior skull base defects, two had defects in the infratemporal fossa, and one each had repairs of clival defects and the face/mandible and maxilla. The second patient who underwent this procedure developed a severe postoperative gram-negative enteric meningitis from which the patient fully recovered. Following this infection, only disposable laparoscopic instruments were used. No further infections at either the donor or recipient sites occurred. There were no CSF leaks and there were no abdominal complications. All grafts survived, that is, there were no failures and no need for revision procedures. Conclusions: Laparoscopic harvesting of free omental tissue for microvascular transfer can be safely and effectively performed and utilized for skull base reconstruction. Only disposable laparoscopic equipment should be used to minimize the risk of recipient site infection. This technique has significant advantages over omental tissue harvesting via laparotomy, and in selected situations, has advantages over other types of free tissue transfer in minimizing donor site morbidity.