Omental Pedicle Grafting in the Treatment of Postcardiotomy Sternotomy Infection

Lovich, Stephen F.; Iverson, Leigh I.G.; Young, J. Nilas; Ennix, Coyness L.; Harrell, James E.; Ecker, Roger R.; Lau, Glen A.; Joseph, Patrick; May, Ivan A.

doi:10.1001/archsurg.1989.01410100094016

Cited by 19 publications

(10 citation statements)

References 14 publications

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“…Recurrence of infection is associated with high mortality, so we routinely transposed the omentum in addition to aggressive debridement following VAC therapy for several weeks. The omental flap is the best selection for preventing recurrence of an infection because of its abundant lymphoid tissues and ability to regenerate blood vessels [4-6]. After sterility of the mediastinal space has been achieved by VAC therapy, harvesting the omentum would not induce the intraperitoneal spread of infection.…”

Section: Discussionmentioning

confidence: 99%

“…The pedicle was brought up into the anterior mediastinum through the front of the liver and fixed to the upper part of the mediastinum. The bilateral pectoralis major muscle was fully mobilized following detachment of the costal insertion, without resecting the humeral insertion, then rotated and sutured together without tension on the midline in a ventral of the omentum flap [2-6]. On the cranial side, half of the clavicular attachment was divided, preserving continuity between the pectoralis-rect abdominis muscle.…”

Section: Methodsmentioning

confidence: 99%

“…The treatment of DSWI has evolved from closed mediastinal antibiotic irrigation to the primary use of a pectoralis muscle flap. Today, established treatment protocols include aggressive surgical debridement, delayed secondary closure, and plastic reconstruction with muscle and omental flaps [1-6]. Despite remarkable advances, mortality rate remains high, and this complication prolongs the hospital stay [7,8].…”

Section: Introductionmentioning

confidence: 99%

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Secondary omental and pectoralis major double flap reconstruction following aggressive sternectomy for deep sternal wound infections after cardiac surgery

Kobayashi

Mikamo

Kurazumi

et al. 2011

J Cardiothorac Surg

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BackgroundDeep sternal wound infection after cardiac surgery carries high morbidity and mortality. Our strategy for deep sternal wound infection is aggressive strenal debridement followed by vacuum-assisted closure (VAC) therapy and omental-muscle flap reconstrucion. We describe this strategy and examine the outcome and long-term quality of life (QOL) it achieves.MethodsWe retrospectively examined 16 patients treated for deep sternal wound infection between 2001 and 2007. The most recent nine patients were treated with total sternal resection followed by VAC therapy and secondary closure with omental-muscle flap reconstruction (recent group); whereas the former seven patients were treated with sternal preservation if possible, without VAC therapy, and four of these patients underwent primary closure (former group). We assessed long-term quality of life after DSWI by using the Short Form 36-Item Health Survey, Version 2 (SF36v2).ResultsOne patient died and four required further surgery for recurrence of deep sternal wound infection in the former group. The duration of treatment for deep sternal wound infection in the recent group was significantly shorter than that in previous group (63.4 ± 54.1 days vs. 120.0 ± 31.8 days, respectively; p = 0.039). Despite aggressive sternal resection, the QOL of patients treated for DSWI was only minimally compromised compared with age-, sex-, surgical procedures-matched patients without deep sternal wound infection.ConclusionsAggressive sternal debridement followed by VAC therapy and secondary closure with an omental-muscle flap is effective for deep sternal wound infection. In this series, it resulted in a lower incidence of recurrent infection, shorter hospitalization, and it did not compromise long-term QOL greatly.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Secondary omental and pectoralis major double flap reconstruction following aggressive sternectomy for deep sternal wound infections after cardiac surgery

Kobayashi

Mikamo

Kurazumi

et al. 2011

J Cardiothorac Surg

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“…[1][2][3][4][5][6][7][8][9][10][11][12] Since the 1980s, débridement and immediate closure with muscle or myocutaneous flaps has gained popularity. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Various muscle flaps have been proposed, including the pectoralis major, rectus abdominis, and latissimus dorsi muscles.…”

mentioning

confidence: 99%

Management of Sternal Wounds with Bilateral Pectoralis Major Myocutaneous Advancement Flaps in 114 Consecutively Treated Patients: Refinements in Technique and Outcomes Analysis

Ascherman

Patel

Malhotra

et al. 2004

Plastic and Reconstructive Surgery

106

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Because life-threatening sternal wound complications can occur following sternotomy, the optimal management of sternal wound infections remains an important topic. To decrease morbidity following operative treatment of these patients, the authors made a number of refinements in their treatment protocol over the past several years, particularly with regard to the extent of débridement, method of flap apposition, and management of drains. The purpose of this study was to obtain specific outcomes data by reviewing a large series of patients treated by a single surgeon. In this series of 114 consecutive sternal wounds treated by the senior author (Ascherman), patients were managed almost exclusively with débridement and immediate closure with bilateral pectoralis major myocutaneous advancement flaps. There were no intraoperative deaths. The 30-day perioperative mortality rate was 7.9 percent, with only one death directly related to sternal infection. Nineteen patients (16.7 percent) experienced postoperative morbidity, including partial wound dehiscences (5 percent), skin edge necrosis (5 percent), and seromas (3.5 percent). The authors advocate single-stage management of complicated sternal wounds with immediate débridement and bilateral pectoralis major myocutaneous advancement flaps. The procedure is rapid and effective. Refinements in technique have significantly lowered morbidity.

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“…[18][19][20][21][22][23] It is impossible to have a comprehensive idea on the general success rate and procedure-related complication rate, since no numerically significant series have been reported in the literature ( Table 1). The risks associated with this procedure are lower than those associated with muscle flaps.…”

mentioning

confidence: 99%

Laparoscopic Harvest of an Omental Flap to Reconstruct an Infected Sternotomy Wound

Tebala

Ciani

Fonsi

et al. 2006

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Sternotomy dehiscence is associated with a high mortality rate. In most cases this complication may be treated by simple debridement and antibiotic therapy, but sometimes it is necessary to fill the sternal defect with viable tissue. The greater omentum seems to be the ideal tissue to be transposed because of its malleability, good vascularization, and high lymphatic tissue content. The transposition of the greater omentum usually requires a midline laparotomy for the preparation of the flap, with significant laparotomy-related morbidity. Laparoscopic access may represent an effective alternative for preparing and transposing the omental flap. The key points of the laparoscopic technique are (1) the coloepiploic detachment, (2) the section of the anastomotic arterial branches between the Barkow's arcade and the gastroepiploic arcade, (3) the mobilization of the greater omentum pedicled on the right gastroepiploic artery, and (4) its transposition into the mediastinum, taking care to avoid twisting the gastric greater curvature and the flap itself.

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Omental Pedicle Grafting in the Treatment of Postcardiotomy Sternotomy Infection

Cited by 19 publications

References 14 publications

Secondary omental and pectoralis major double flap reconstruction following aggressive sternectomy for deep sternal wound infections after cardiac surgery

Secondary omental and pectoralis major double flap reconstruction following aggressive sternectomy for deep sternal wound infections after cardiac surgery

Management of Sternal Wounds with Bilateral Pectoralis Major Myocutaneous Advancement Flaps in 114 Consecutively Treated Patients: Refinements in Technique and Outcomes Analysis

Laparoscopic Harvest of an Omental Flap to Reconstruct an Infected Sternotomy Wound

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