Various Free Intestinal Flaps and Omentum for Reconstruction of Defects

The abdomen is an ample source of donor sites for a variety of flaps, including the jejunum, parts of the stomach, ileum, ileocolon, appendix, omentum, etc. The abdominal viscera can be used for reconstruction of the esophagus, voice tube, oral mucosa, urethra, ureter, vagina, uterine cervix, etc. The omentum can be used for wound coverage. However, there are limitations of raising visceral flaps: (1) short duration of ischemia tolerance, (2) laparotomy requirement with its associated potential risk, (3) old age (significant comorbidities or intestinal adhesion due to previous abdominal surgeries may exclude patients from the operation), (4) traditionally laparotomy is considered to be more dangerous by the patients when compared with harvesting skin or muscle flaps from the extremities, and (5) these flaps are to be raised by general surgeons, who may decline their service especially late at night. With the improvement of laparoscopic surgery, abdominal viscera can be harvested with less invasive procedures and has gained in popularity in modern surgery. We suggest that the use of flaps from intra-abdominal organs should be directed by senior plastic surgeons who are also familiar with general surgery. In certain areas of reconstruction, the result can be better than regular skin flaps.