Systematic Review of Outcomes of Omental Free Flap in the Management of Lymphedema.

Background: The omentum has unique angiogenic and immunologic properties, and its low risk of donor-site lymphedema makes it an ideal donor site for lymph node transfer. However, it is unpopular due to the technicalities and the possibility of donor site-related abdominal complications during its harvest.

Methods: A systematic review was conducted on March 24, 2024, using PubMed, Scopus, and Ovid MEDLINE databases. The search terms "omental flap," "omentum flap," "lymphedema," and "free flap" yielded 99 articles. Only 7 full-text articles published within the past 25 years focusing on omental free flap for lymphedema management were included.

Results: The review included 7 studies comprising 131 patients, predominantly women, with an average age of 54.75 years, most of whom had secondary lymphedema, primarily due to breast cancer. Clinical outcome measures showed significant limb volume reduction and improved lymphatic drainage, whereas patient-reported outcome measures indicated overall patient satisfaction and improved quality of life. The flap failure rate was 0.75%, and partial flap necrosis occurred in 2.25% of cases. Common donor-site complications included abdominal tension (2.29%) and dyspepsia (1.53%).

Conclusions: This systematic review highlights the promising outcomes of omental free flap in lymphedema management, with low complication rates and significant improvements in both clinical and patient-reported outcomes.