Omental Transfer as a Method of Preventing Residual Persistent Subcutaneous Infection After Mediastinitis

Yoshida, Katsuhiko; Ohshima, Hideki; Murakami, Fumihiko; Tomida, Y; Matsuura, Akio; Hibi, M; Kawamura, Mitsuo

doi:10.1016/s0003-4975(96)01122-8

Cited by 13 publications

(8 citation statements)

References 4 publications

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“…There are many reports concerning the effectiveness of using omentum to cover the graft as a means of preventing graft infection. 5,17 –20 Among the 5 patients in this study in whom an omental flap was used, 2 had TAAA, 2 had descending TAA, and one had an ascending aortic aneurysm. It was possible to transfer the omentum with the pedicle to the whole range of possible thoracic aortic aneurysm locations.…”

Section: Discussionmentioning

confidence: 90%

Graft for Mycotic Thoracic Aortic Aneurysm: Omental Wrapping to Prevent Infection

Kuniyoshi

Koja

Miyagi

et al. 2005

Asian Cardiovasc Thorac Ann

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Nine cases of mycotic thoracic aortic aneurysm were treated surgically between July 1995 and March 2003. The aneurysms were located in the ascending aorta in 1 patient, the descending thoracic aorta in 5, and the thoracoabdominal aorta in 3. Preoperatively, 3 patients were in shock due to rupture of the aneurysm. All patients underwent aneurysmectomy and in-situ graft placement. In 5 patients, the graft was covered with a pedicled omental flap to prevent postoperative graft infection. There were 2 hospital deaths: one patient died of multi-organ failure, and the other died from intrathoracic bleeding. After discharge, one patient died from intrathoracic bleeding 3 months after surgery. These 3 patients had not received omental wrapping. Postoperative graft infection did not occur in the 6 surviving patients during a mean follow-up period of 4.0 +/- 3.1 years. It was concluded that covering the prosthetic graft with a pedicled omental flap may help prevent postoperative graft infection and improve the surgical results.

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Section: Discussionmentioning

confidence: 90%

Graft for Mycotic Thoracic Aortic Aneurysm: Omental Wrapping to Prevent Infection

Kuniyoshi

Koja

Miyagi

et al. 2005

Asian Cardiovasc Thorac Ann

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“…In these situations, reconstructions using a variety of muscle flaps, sometimes together with omentoplasty, have been described. (8,9,27,29,30) In the present study, major pectoral muscle flaps were used in conjunction with omentopexy in 10 of the patients in groups B and C.…”

Section: Discussionmentioning

confidence: 99%

“…(15,21,26) The use of the greater omentum to fill the anterior mediastinum presents the following advantages: it is an excellent vascular supply; it is usually large; it apparently promotes angiogenesis and is resistant to infections; and it facilitates the primary closure of superficial tissues, with excellent aesthetic results. (7,17,(28)(29)(30) Among the disadvantages, we can mention the possible contamination of the peritoneal cavity, the potential for the onset of epigastric hernia, and the lesser stabilization of the anterior chest wall in comparison with that obtained using muscle flaps. In addition, omentoplasty serves as an exceptional alternative in cases of muscle flap treatment failure.…”

Section: Discussionmentioning

confidence: 99%

Tratamento agressivo com retalho muscular e/ou omentopexia nas infecções do esterno e mediastino anterior em pós-operatório de esternotomia

et al. 2008

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OBJETIVO: Avaliar o impacto do tratamento agressivo com retalho muscular e/ou omentopexia nas infecções do esterno e mediastino anterior em pós-operatório de esternotomia sobre a mortalidade, comparando-o ao do tratamento conservador. MÉTODOS: Foram coletados dados pré-, trans- e pós-operatórios. O grupo A (n = 44) incluiu pacientes submetidos ao tratamento conservador-desbridamento associado a ressutura e/ou a irrigação contínua com solução de polivinilpirrolidona-iodo, ou ainda a cicatrização por segunda intenção (dados retrospectivos). O grupo B (n = 9) incluiu pacientes nos quais não houve resolução da infecção com o tratamento conservador e que, por isso, foram submetidos ao tratamento agressivo (fase intermediária). O grupo C (n = 28) incluiu pacientes submetidos primariamente ao tratamento agressivo (dados prospectivos). RESULTADOS: Identificou-se menor tempo de internação pós-operatória nos pacientes submetidos ao tratamento agressivo (p < 0,046). Houve 7 óbitos no grupo A, 1 no grupo B e 2 no grupo C. Entretanto, o nível de significância clássico de α = 0,05 não foi atingido. CONCLUSÕES: O tratamento agressivo mostrou-se também adequado para aquelas infecções em que o tratamento conservador não foi resolutivo. Esses achados demonstram que o tratamento proposto tem excelentes resultados.

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“…The omentum also has a distinct role in the sealing of intestinal perforation in premature neonates [2] and in healing resistant sternal wounds (following infected sternotomy incisions) [6], [14]. Experimental studies have demonstrated that omentum can potentially prevent or reduce occurrence of infection following artificial aortic graft implantation [15], [16]. However, the underlying cellular and molecular mechanisms involved in the omentum- mediated prevention of infections and healing of injured organs remains poorly understood.…”

Section: Discussionmentioning

confidence: 99%

The Anti-Inflammatory and Antibacterial Basis of Human Omental Defense: Selective Expression of Cytokines and Antimicrobial Peptides

et al. 2011

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BackgroundThe wound healing properties of the human omentum are well known and have extensively been exploited clinically. However, the underlying mechanisms of these effects are not well understood. We hypothesize that the omentum tissue promotes wound healing via modulation of anti-inflammatory pathways, and because the omentum is rich in adipocytes, the adipocytes may modulate the anti-inflammatory response. Factors released by human omentum may affect healing, inflammation and immune defense.MethodologySix human omentum tissues (non obese, free from malignancy, and any other systemic disorder) were obtained during diagnostic laparoscopies having a negative outcome. Healthy oral mucosa (obtained from routine oral biopsies) was used as control. Cultured adipocytes derived from human omentum were exposed to lipopolysaccharide (LPS) (1–50 ng/mL) for 12–72 hours to identify the non-cytotoxic doses. Levels of expression (mRNA and protein) were carried out for genes associated with pro- and anti-inflammatory cytokine responses and antibacterial/antimicrobial activity using qRT-PCR, western blotting, and cell-based ELISA assays.ResultsThe study shows significant higher levels of expression (mRNA and protein) of several specific cytokines, and antibacterial peptides in the omentum tissues when compared to oral sub-mucosal tissues. In the validation studies, primary cultures of adipocytes, derived from human omentum were exposed to LPS (5 and 10 ng/mL) for 24 and 48 h. The altered expressions were more pronounced in cultured adipocytes cells when exposed to LPS as compared to the omentum tissue.Conclusions/SignificancePerhaps, this is the first report that provides evidence of expressional changes in pro- and anti-inflammatory cytokines and antibacterial peptides in the normal human omentum tissue as well as adipocytes cultured from this tissue. The study provides new insights on the molecular and cellular mechanisms of healing and defense by the omentum, and suggests the potential applicability of cultured adipocytes derived from the omentum for future therapeutic applications.

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Omental Transfer as a Method of Preventing Residual Persistent Subcutaneous Infection After Mediastinitis

Cited by 13 publications

References 4 publications

Graft for Mycotic Thoracic Aortic Aneurysm: Omental Wrapping to Prevent Infection

Graft for Mycotic Thoracic Aortic Aneurysm: Omental Wrapping to Prevent Infection

Tratamento agressivo com retalho muscular e/ou omentopexia nas infecções do esterno e mediastino anterior em pós-operatório de esternotomia

The Anti-Inflammatory and Antibacterial Basis of Human Omental Defense: Selective Expression of Cytokines and Antimicrobial Peptides

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