Free Flap Reconstruction Using an Omental Flap Transferred 18 Years Prior to a Recipient Vessel

Abstract

　We report a case involving the pedicle of a previously transferred omental flap that was used as a recipient vessel in the microsurgical reconstruction of a right orbital sebaceous adenocarcinoma. A 65-year-old male with right maxillary sinus squamous cell carcinoma underwent extended total maxillectomy and anterolateral skull base reconstruction using a free rectus abdominis musculocutaneous flap after chemotherapy and radiation therapy. Postoperative cranial osteomyelitis developed and was treated with a free omental flap. Fifteen years later, he developed a right sebaceous carcinoma in the eyelid and underwent eyelid resection, oophorectomy, and a meshed skin graft. Three years later, local recurrence involving the skull base was observed. Because of the difficulty in reconstruction with a local flap, the defect was reconstructed using a free radial forearm flap. The pedicle of the omental flap was used for the recipient vessel because there was almost no scarring around the vessels, especially the veins. The postoperative course was uneventful.　Unlike the “Tsugiki” method, the pedicle of the previously transferred omental flap, especially its vein, showed almost no scarring. This suggests its usefulness as a recipient vessel for multiple free-flap transfers.