Laparoscopic omental flap for the treatment of major sternal wound infection after cardiac surgery

Puma, Francesco; Fedeli, Costanzo; Ottavi, Paolo; Porcaro, Giuseppina; Fonsi, Giovanni Battista; Pardini, Alessandro; Daddi, G

doi:10.1016/s0022-5223(03)00709-8

Cited by 29 publications

(21 citation statements)

References 14 publications

(24 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The former was developed for the treatment of tuberculosis and is sometimes used for reconstruction when the last ribs are demolished, so the thoracic defect is transformed into an abdominal defect, avoiding thoracic and ventilation complications (1). Whereas the latter is used for infected or irradiated wounds; in these cases, a well-vascularised flap is preferable for eliminating infections and has been proven to be effective for treating deep sternal contaminations (14,15). In our series, we report on three cases of sternal allograft transplantation; a technique considered experimental up until a few years ago.…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary approach to chest wall resection and reconstruction for chest wall tumors, a single center experience

Scarnecchia¹,

Liparulo²,

Pica³

et al. 2017

J. Thorac. Dis.

Self Cite

View full text Add to dashboard Cite

Background: Chest wall resection and reconstruction (CWRR) is quite challenging in surgery, due to evolution in techniques. Neoplasms of the chest wall, primary or secondary, have been considered inoperable for a long time. Thanks to evolving surgical techniques, reconstruction after extensive chest wall resection is possible with good functional and aesthetic results. Conclusions: Surgical planning is most effective when it is tailored to the patient. Specifically, in the treatment of selected chest wall tumors, the multidisciplinary approach is considered mandatory when an extensive demolition is required. Indeed, here, the radical wide en-bloc resection can lead to good results provided that the extent of resection is not influenced by any anticipated problem in reconstruction.

show abstract

Section: Discussionmentioning

confidence: 99%

Multidisciplinary approach to chest wall resection and reconstruction for chest wall tumors, a single center experience

Scarnecchia¹,

Liparulo²,

Pica³

et al. 2017

J. Thorac. Dis.

Self Cite

View full text Add to dashboard Cite

show abstract

“…Laparoscopically harvested omentoplasty, compared to the open procedure, is a minimally invasive technique with several advantages, for example, a decrease in the chance of herniation of the donor site [17]. …”

Section: Discussionmentioning

confidence: 99%

Deep sternal wound infection after open heart surgery: current treatment insights. A retrospective study of 36 cases

et al. 2011

View full text Add to dashboard Cite

The aim of this study was to retrospectively evaluate the results of reconstructing infected post-sternotomy wounds, with either sternal plating and/or pectoralis major flap transposition or pedicled omentoplasty after previous vacuum-assisted closure (VAC) therapy. Between January 2005 and December 2010, 36 patients, suffering from deep sternal wound infection (DSWI) after coronary artery bypass grafting procedure, received (plastic) reconstructive surgery. All patients, treated in the Maastricht University Medical Centre (Departments of Plastic Surgery and Cardiothoracic Surgery), were selected for this study. For 22 patients, sternal refixation and reconstruction were obtained by sternal internal plate fixation combined with bilateral pectoralis major advancement flap. In 11 patients, a pedicled omentoplasty was performed, with or without split-skin graft and additional VAC therapy. Three patients only received a pectoralis plasty. We evaluated preoperative characteristics and post-operative course. Twenty-four patients (66.7%) had an uneventful post-operative course. Complications in the other patients included wound dehiscence, herniation of the donor site and infection of sternal plating material. Average sternal wound healing after sternal plating plus pectoralis plasty, pectoralis plasty and omentoplasty respectively accounted 7.7, 8.0 and 11.6 weeks. From our experience, we recommend VAC therapy plus delayed sternal plating and additional bilateral pectoralis major flap advancement as first repair option in case of DSWI. However, individual clinical conditions need to be taken into account when making a decision between the different available reconstructive options. Omentoplasty should be reserved for cases in which the sternum has recurrently fallen open after previous sternal plate refixation, or for cases in which the sternum defect is too extended.

show abstract

“…The ability to lengthen omentum as a vascular pedicle [3,14] or transplant it as a free microvascular flap [31] has widened the range of applications in human surgery to include gastrointestinal, urogenital, thoracic, vascular, neurological and reconstructive procedures [2]. Management of chronic osteomyelitis by omental microvascular transplantation has been reported [6] and omental pedicle transposition has been used to treat sternal osteomyelitis and mediastinitis [36,26]. Omentalisation has been used in veterinary surgery for the treatment of prostatic abscessation, pyothorax, chronic axillary wounds in cats, chest wall defects and diaphragmatic hernias [10,37].…”

Section: Introductionmentioning

confidence: 99%

Omentalisation as adjunctive treatment of an infected femoral nonunion fracture: a case report

McAlinden¹,

Glyde

McAllister

et al. 2009

Ir Vet J

View full text Add to dashboard Cite

A three-year-old male working border collie with an infected femoral nonunion fracture was managed in a two-stage procedure involving debridement and omentalisation, followed by stabilisation with a bone plate and an autogenous cancellous bone graft. Osseous union was documented radiographically 16 weeks after surgery. Telephone follow-up one year later revealed the dog had returned to full working function without evidence of lameness. To the authors' knowledge, this is the first clinical case described in the veterinary literature using omentalisation as an adjunct to the management of an infected, biologically inactive nonunion fracture.

show abstract

Laparoscopic omental flap for the treatment of major sternal wound infection after cardiac surgery

Abstract: Laparoscopic omentoplasty, compared with the open procedure, entails several advantages for the treatment of sternal osteomyelitis. The introduction of minimally invasive techniques may widen the indications for the use of the omentum in the treatment of major sternal wound infections.

Cited by 29 publications

References 14 publications

Multidisciplinary approach to chest wall resection and reconstruction for chest wall tumors, a single center experience

Multidisciplinary approach to chest wall resection and reconstruction for chest wall tumors, a single center experience

Deep sternal wound infection after open heart surgery: current treatment insights. A retrospective study of 36 cases

Omentalisation as adjunctive treatment of an infected femoral nonunion fracture: a case report

Contact Info

Product

Resources

About