Objective: To present the use of an infrequently used tool, gastro-omental free flaps, available to head and neck surgeons in the modern reconstruction era. Methods: In this case series, 25 gastro-omental free flaps were performed. The technical aspects of harvest are reviewed, and the advantages and disadvantages of this flap are described, as well as illustrative cases displaying this flap's utility when other donor sites cannot be harvested. Results: Flap survival was 96%, with 1 flap being successfully salvaged after the development of a venous thrombosis and 1 flap failing as a result of a kink in the arterial pedicle. Exteriorization of the omentum as an external marker heralded vascular compromise in both cases. Complications included 2 delayed gastric outlet obstructions, 1 salivary leak, 1 delayed abscess and fistula formation 7 months following reconstruction, and 1 case of mild superficial bleeding from the transplanted gastric mucosa. Conclusion: The gastro-omental flap has proven to be a reliable and valuable tool in head and neck reconstruction, particularly in complex oropharyngeal wounds with large soft tissue components.
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