Background. Severe intraoperative bleeding cannot always be controlled by standard surgical techniques. We recently reported a new technique to repair serious vascular injury using a free graft of omentum or rectus abdominus fascia as an overlay autogenous tissue (OAT) patch in the experimental sheep model. We now describe the successful clinical use of this patch in three patients.Case Reports. Radical surgery was performed on three patients with pelvic malignancy with resulting uncontrollable bleeding from the internal iliac vein, pelvic side wall and paravaginal venous plexuses, respectively. Hemostasis was secured using an OAT patch made of abdominus rectus fascia in two cases and appendix epiploicae as an omental substitute in the other.Discussion. The utility of the OAT patch is described in three different clinical situations. It is suggested that this technique may be especially useful to gynecologic oncologists when standard surgical techniques fail to control bleeding or there is limited access to the site of injury. (C) 2004 Elsevier Inc. All rights reserved.