July 9, 1982

Use of omentum for stroke: dream or reality?

JAMA. 1982;248(2):155-161. doi:10.1001/jama.1982.03330020005002

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Medicine has little to offer patients who have long-standing neurological deficits as a result of stroke. Even most centers that do cerebral artery bypass surgery choose patients who have recently suffered a completed stroke and have no major residual deficits.

In the last few years, Harry Goldsmith, MD, professor of surgery, Dartmouth Medical School, Hanover, NH, has stepped into this no-man's-land with an intriguing new brain revascularization procedure called omental transposition. In this operation, the abdomen is opened and the omentum freed from some of its attachments and extensively lengthened. The intact membrane is then passed through a subcutaneous tunnel along the chest and neck to just behind the ear, brought out under a skin flap, and applied to the surface of the brain through an opening in the skull.

According to Goldsmith, the tremendous vascularity of the omentum makes it ideal for restoring blood supply to ischemic areas, such