title: Omental pedicle flaps following proctectomy: a systematic review.
abstract: OBJECTIVE
  Abdominoperineal excision (APR) for cancer carries significant morbidity of the perineal wound. An omental pedicle graft has been used to fill the pelvis and limit attendant complications after radical extirpation of the anorectum. A review of the literature was conducted to determine whether omentoplasty following APR reduces perineal wound complications.
  
  
  METHODS
  Three major databases (PubMed, MEDLINE and the Cochrane Library) were searched. The review included original articles reporting outcomes after APR and omentoplasty from January 1950 to July 2012.
  
  
  RESULTS
  Fourteen studies involving 891 patients (mean age 61 years, 59.8% men) were included. Median follow-up was 13.5 months. A variety of omentoplasty techniques added a median of 20 min to the operating time. The mean rate of primary wound healing was 66.8%, time to wound healing 24 days and weighted mean wound infection rate 14.4% with omentoplasty compared with 50.1%, 79 days and 18.5% in patients having no omentoplasty.
  
  
  CONCLUSIONS
  Omental mobilization, transfer and buttressing of primary perineal repair following proctectomy reduces perineal wound morbidity with minimal additional operating time or flap-associated morbidity.
authors.affiliation: Surgical Professorial Unit, St Vincent's University Hospital, Dublin, Ireland.
authors.forename: S
authors.initials: S
authors.lastname: Killeen
authors.forename: A
authors.initials: A
authors.lastname: Devaney
authors.forename: M
authors.initials: M
authors.lastname: Mannion
authors.forename: S T
authors.initials: ST
authors.lastname: Martin
authors.forename: D C
authors.initials: DC
authors.lastname: Winter
mesh_terms: D006801:Humans; D007902:Length of Stay; D009852:Omentum / Q000601:surgery*; D061646:Operative Time; D010502:Perineum / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology*; D012004:Rectal Neoplasms / Q000601:surgery*; D012086:Reoperation; D013524:Surgical Flaps; D013997:Time Factors; D058106:Wound Closure Techniques; D014945:Wound Healing
keywords: Proctectomy; omental pedicle flaps; wound healing; wound infection