O omento maior tem sido utilizado com grande eficácia na medicina e em cirurgias torácicas, urogenitais, neurológicas, vasculares e respiratórias por sua natureza única, versátil e suas propriedades de imunidade, drenagem, adesão, vascularização e hemostasia bem conhecidas. Tem sido aplicado em humanos, como uma importante fonte de vascularização para áreas distantes, como flap pediculado ou livre, dentre elas, tórax, cabeça, pescoço e porções proximais de extremidades. As pesquisas com flap pediculado de omento maior, na cirurgia veterinária como indutor angiogênico e imunogênico são poucas, entretanto, suas propriedades de adesão e drenagem são conhecidas e utilizadas em procedimentos cirúrgicos com excelentes resultados. O objetivo desta pesquisa foi criar retalho pediculado de omento maior, mensurando o comprimento durante as etapas de criação e avaliando a possibilidade de alcance para ossos longos (fêmur, tíbia, úmero e rádio e ulna) através de túnel subcutâneo. Foram utilizados 30 cadáveres de cães frescos com 10 a 30 quilos de massa corpórea, sem discriminação de idade, sexo ou raça. Os resultados foram satisfatórios e 100% dos animais alcançaram a metáfise distal dos ossos avaliados. A média de comprimento do omento em camada dupla, dos 30 animais avaliados foi de 30,87 cm, da camada simples de 54,37 cm e do flap em L 92,7 cm. Com a extensão máxima do omento foi possível alcançar as metáfises distais de todos os ossos propostos (fêmur, tíbia/fíbula, úmero e rádio/ulna), com comprimento médio excedente de 29,87 cm para fêmur, 20,73 cm para tíbia/fíbula, 25,13 cm para úmero e 16,27 cm para rádio/ulna As variáveis peso flap em L avaliadas estatisticamente apresentaram correlação positiva moderada nos grupos apresentados. Concluiu-se que em cães é possível levar o flap pediculado de omento maior através de túnel subcutâneo para metáfise distal de ossos longos sem tensão e que quanto maior o peso do animal, maior o comprimento do flap em L dos animais avaliados em cada grupo. / The greater omentum has been successfully used in human medicine in different surgical approaches such as thoracic, urogenital, neurological, vascular, and respiratory. The high usefulness of omentum is due to its singular nature and versatility, as well as its known different properties such as immunologic, drainage, adhesion, angiogenic and haemostatic. It has been used in human medicine such as a pediculated or free flap as an important vascular inductor for different areas. Among the sites that it has been used to increase blood flow by its angiogenic properties, little the thorax, head and neck, and proximal and distal extremities may be sited. Research on immunogenic and angiogenics inductor properties of the flap in Veterinary Medicine have been made, however, its adhesive and draining properties are well known and have been used with excellent results in surgery. An experimental study to obtain a pediculated flap of greater omentum and conduct it as far as possible through a subcutaneous tunnel in order to reach long bones (femur, tibia, umero, radius and ulna). Was designed during the experiment, the obtained different flaps were measured and the possibility of reaching proximal to distal long bone sites was checked. For the experiment 30 fresh body (10 to 30 kg of corporal weight) from dead dogs without predilection to age, or sex were used. Animals of all breeds were included except condrosdistrophics breeds. In addition, dogs with signs of abdominal surgery, abdominal adherences, or other anatomic dysfunctions of the greater omentum were excluded from the experiment. The results were satisfactor and in 100% of the cases the flap reached the distal half of the evaluated bones. The averages of the different flap lengths were: 30.87 cm when double layer was used; 54.37 cm in simple layer; and 92.7 cm when the flap was made in an L shape. With the largest extension of the omentum, it was possible to reach the distal metaphises of all studied bones (femur, tibia/fibula, humerus, and radius/ulna). The exceeding length average was 29.87 cm for the femur, 20.73 cm for the tibia/fibula, 25.13 cm for the humerus, and 16.27 cm for the radius/ulna. The variation body-weight-flap variety statistically evaluated showed moderate positive correlation on the presented groups. In conclusion, the omentum pediclulated flap may be passed through the subcutaneous tunnel until the distal metaphisis of the long bones of dogs without tension. Animals with carger bodyl weight have the largest length of the L- shaped flap.

O omento maior tem sido utilizado com grande eficácia na medicina e em cirurgias torácicas, urogenitais, neurológicas, vasculares e respiratórias por sua natureza única, versátil e suas propriedades de imunidade, drenagem, adesão, vascularização e hemostasia bem conhecidas. Tem sido aplicado em humanos, como uma importante fonte de vascularização para áreas distantes, como flap pediculado ou livre, dentre elas, tórax, cabeça, pescoço e porções proximais de extremidades. As pesquisas com flap pediculado de omento maior, na cirurgia veterinária como indutor angiogênico e imunogênico são poucas, entretanto, suas propriedades de adesão e drenagem são conhecidas e utilizadas em procedimentos cirúrgicos com excelentes resultados. O objetivo desta pesquisa foi criar retalho pediculado de omento maior, mensurando o comprimento durante as etapas de criação e avaliando a possibilidade de alcance para ossos longos (fêmur, tíbia, úmero e rádio e ulna) através de túnel subcutâneo. Foram utilizados 30 cadáveres de cães frescos com 10 a 30 quilos de massa corpórea, sem discriminação de idade, sexo ou raça. Os resultados foram satisfatórios e 100% dos animais alcançaram a metáfise distal dos ossos avaliados. A média de comprimento do omento em camada dupla, dos 30 animais avaliados foi de 30,87 cm, da camada simples de 54,37 cm e do flap em L 92,7 cm. Com a extensão máxima do omento foi possível alcançar as metáfises distais de todos os ossos propostos (fêmur, tíbia/fíbula, úmero e rádio/ulna), com comprimento médio excedente de 29,87 cm para fêmur, 20,73 cm para tíbia/fíbula, 25,13 cm para úmero e 16,27 cm para rádio/ulna As variáveis peso flap em L avaliadas estatisticamente apresentaram correlação positiva moderada nos grupos apresentados. Concluiu-se que em cães é possível levar o flap pediculado de omento maior através de túnel subcutâneo para metáfise distal de ossos longos sem tensão e que quanto maior o peso do animal, maior o comprimento do flap em L dos animais avaliados em cada grupo. / The greater omentum has been successfully used in human medicine in different surgical approaches such as thoracic, urogenital, neurological, vascular, and respiratory. The high usefulness of omentum is due to its singular nature and versatility, as well as its known different properties such as immunologic, drainage, adhesion, angiogenic and haemostatic. It has been used in human medicine such as a pediculated or free flap as an important vascular inductor for different areas. Among the sites that it has been used to increase blood flow by its angiogenic properties, little the thorax, head and neck, and proximal and distal extremities may be sited. Research on immunogenic and angiogenics inductor properties of the flap in Veterinary Medicine have been made, however, its adhesive and draining properties are well known and have been used with excellent results in surgery. An experimental study to obtain a pediculated flap of greater omentum and conduct it as far as possible through a subcutaneous tunnel in order to reach long bones (femur, tibia, umero, radius and ulna). Was designed during the experiment, the obtained different flaps were measured and the possibility of reaching proximal to distal long bone sites was checked. For the experiment 30 fresh body (10 to 30 kg of corporal weight) from dead dogs without predilection to age, or sex were used. Animals of all breeds were included except condrosdistrophics breeds. In addition, dogs with signs of abdominal surgery, abdominal adherences, or other anatomic dysfunctions of the greater omentum were excluded from the experiment. The results were satisfactor and in 100% of the cases the flap reached the distal half of the evaluated bones. The averages of the different flap lengths were: 30.87 cm when double layer was used; 54.37 cm in simple layer; and 92.7 cm when the flap was made in an L shape. With the largest extension of the omentum, it was possible to reach the distal metaphises of all studied bones (femur, tibia/fibula, humerus, and radius/ulna). The exceeding length average was 29.87 cm for the femur, 20.73 cm for the tibia/fibula, 25.13 cm for the humerus, and 16.27 cm for the radius/ulna. The variation body-weight-flap variety statistically evaluated showed moderate positive correlation on the presented groups. In conclusion, the omentum pediclulated flap may be passed through the subcutaneous tunnel until the distal metaphisis of the long bones of dogs without tension. Animals with carger bodyl weight have the largest length of the L- shaped flap.

L’incidence de l’ischémie critique est en augmentation depuis ces vingt dernières années. La revascularisation diminue le taux d’amputation. Les plaies ischémiques infectées avec l’exposition des tendons, des os ou des articulations, ne peuvent pas cicatriser avec la revascularisation et le débridement local. La chirurgie, associant un pontage veineux distal ou une recanalisation et un lambeau libre, permet de traiter les pertes de substances et présente un avantage hémodynamique en augmentant le débit du pontage grâce au lit vasculaire ajouté par le lambeau. Nous proposons une nouvelle technique chirurgicale basée sur l’utilisation d’une unité anatomique unique, le lambeau-pontage épiploïque (LPE). Il est composé d’un axe artériel, l’artère gastroépiploïque (AGE), qui procure le greffon, et du grand épiploon, utilisé comme lambeau irrigué par une ou plusieurs branches épiploïques. Le but de ce travail était d’analyser la faisabilité anatomique d’un LPE et de valider le scanner pour l’évaluation préopératoire de l’AGE. Nous avons également évalué les effets hémodynamiques de cette technique et analysé la première expérience clinique. 100 dissections anatomiques ont été réalisées afin de mesurer les diamètres et les longueurs de l’AGE droite et de ses branches, ainsi qu’une radiographie après injection de produit radio-opaque. Pour évaluer la faisabilité préopératoire, nous avons étudié 30 tomodensitométries. Nous avons également exploré les effets hémodynamiques dans le modèle porcin. Notre étude anatomique confirme la faisabilité d’un LPE. La longueur moyenne de l’AGE est de 24,5 cm. Le diamètre proximal moyen est de 3 mm et celui distal est de 1,5 mm. Les données de l’étude radiologique montrent que le scanner peut être utilisé pour le repérage préopératoire de l’AGE et la faisabilité d’un LPE. Les mesures hémodynamiques ont montré que, grâce au lambeau épiploïque, le débit sanguin du pontage augmente et que les résistances distales diminuent. Le LPE est une technique chirurgicale qui doit permettre de repousser les limites de sauvetage de membre dans les conditions de cette pathologie extrême, réalisant une revascularisation distale et une couverture simultanée des pertes de substances chez les patients atteints d’artériopathie. / The incidence of critical limb ischemia increases with the ageing of the population. Often, revascularization decreases the rate of amputation. In some cases, infected wounds with exposure of the tendons, bones or articulations will not heal only with revascularization and local debridement. Surgery combining a distal venous bypass or recanalisation and a free flap can treat those wounds, the vascular bed added by the flap improve the hemodynamic and increases the flow in the bypass. We proposed a new surgical method based on the use of a single anatomical unit, the epiploic flow-through flap (FTF), the gastroepiploic artery (GEA) as the vascular substitute and the greater omentum as the flap. The aim of this work was to analyze the anatomical feasibility of an epiploic BF, and to validate CT scan for preoperative assessment of the suitability of the GEA. We also aimed to evaluate the hemodynamic effects of this technique and to analyze the first clinical experience. 100 anatomical dissections were performed in order to measure the diameters and the lengths of GEA and its branches. An extensive X-ray study was also carried out with injection of a radiopaque product. To evaluate preoperative feasibility of the omental FTF, we studied radiological properties of the GEA on 30 routine CT scans. Finally, we also explored the hemodynamic behavior of this artery and its related flap in porcine models. Our anatomical study confirms the feasibility of a FTF. The average available length of GEA is 245 mm. The average proximal diameter is 3 mm and the distal one is 1.5 mm. Data of radiological study show that CT scan can be used to indicate GEA suitability for an epiploic FTF. The hemodynamic measures showed that thanks to the flap, the blood flow increase in the bypass. Ultimately,we report our first clinical application of the omental FTF for distal lower limb revascularization combined to wound coverage, with successful outcome. Epiploic FTF is a surgical technique, which allows distal revascularization and a simultaneous cover of the limb extremity. This technique can be useful in patients requiring a distal revascularization associated with the coverage of large the wounds