Omental Transposition Flap for Sternal Wound Reconstruction in Diabetic Patients

Stump, Amy L.; Bedri, Mazen I.; Goldberg, Nelson H.; Silverman, Ronald P.

doi:10.1097/sap.0b013e3181c9c31a

Cited by 22 publications

(24 citation statements)

References 23 publications

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“…In addition, several previous literatures suggested that the use of omentum may be associated with lower mortality and fewer complications when compared with the pectoralis muscle flap. [23,24] However, an abdominal wall hernia will occur if the omentum is passed subcutaneously. Moreover, omentum may not be available in those patients with intra-abdominal adhesion after previous surgery.…”

Section: Discussionmentioning

confidence: 99%

Management of the extensive thoracic defects after deep sternal wound infection with the rectus abdominis myocutaneous flap

Zhao²,

Yang³

et al. 2017

Medicine

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Deep sternal wound infection is a severe complication after open heart surgery. According to the different severity and dimensions of the deep sternal wound infection, the treatment method is different. In this study, we aimed to describe our experience with the rectus abdominis myocutaneous flap for large sternal wound management, especially when 1 or 2 internal mammary arteries were absent.Between October 2010 and January 2016, a retrospective review of 9 patients who suffered from the extensive thoracic defects after deep sternal wound infection was conducted. All of these sternal defects encompassed almost the full length of the sternum after debridement. Defect reconstruction was achieved by covering with a rectus abdominis myocutaneous flap. When the ipsilateral or bilateral internal mammary artery had been harvested previously, we took advantage of the inferior epigastric artery to provide additional blood supply to the rectus abdominis myocutaneous flap. Thus, this flap had a double blood supply.There was no recurrent infection in all 9 patients. Three patients received the rectus abdominis myocutaneous flap with a double blood supply. Flap complications occurred in 2 patients (22%). One patient who did not have the double blood supply flap suffered from necrosis on the distal part of the flap, which was then debrided and reconstructed with a split-skin graft. The other patient had a seroma at the abdomen donor site and was managed conservatively. None of the patients died during the hospital stay.This study suggests that the rectus abdominis myocutaneous flap may be a good choice to repair the entire length of sternal wound. When 1 or 2 internal mammary arteries have been harvested, the inferior epigastric artery can be anastomosed to the second intercostal artery or the internal mammary artery perforator to provide the rectus abdominis myocutaneous flap with a double blood supply.

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Section: Discussionmentioning

confidence: 99%

Management of the extensive thoracic defects after deep sternal wound infection with the rectus abdominis myocutaneous flap

Zhao²,

Yang³

et al. 2017

Medicine

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“…Usually, the use of omentum is considered in the case of complex wounds or when the defect is extremely wide with significant sternal loss. Specifically, a definite preference has been expressed for the use of omentum when the primary causative pathogen is particularly resistant, such as MRSA [80,89] and Candida [90] or when the patients suffering from diabetes mellitus [91] . However, complications occurred in up to 18% of patients treated with this approach [16,92] .…”

mentioning

confidence: 99%

Deep sternal wound infection after cardiac surgery: Evidences and controversies

Cotogni

Barbero

Rinaldi

2015

WJCCM

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Despite many advances in prevention and perioperative care, deep sternal wound infection (DSWI) remains a pressing concern in cardiac surgery, with a still relevant incidence and with a considerable impact on in-hospital mortality and also on mid-and long-term survival. The permanent high impact of this complication is partially related to the increasing proportion of patients at highrisk for infection, as well as to the many patient and surgical risk factors involved in the pathogenesis of DSWI. The prophylactic antibiotic therapy is one of the most important tools in the prevention of DSWI. However, the choice of antibiotic, the dose, the duration, the adequate levels in serum and tissue, and the timing of antimicrobial prophylaxis are still controversial. The treatment of DSWI ranges from surgical revision with primary closure to surgical revision with open dressings or closed irrigation, from reconstruction with soft tissue flaps to negative pressure wound therapy (NPWT). However, to date, there have been no accepted recommendations regarding the best management of DSWI. Emerging evidence in the literature has validated the efficacy and safety of NPWT either as a single-line therapy, or as a "bridge" prior to final surgical closure. In conclusion, the careful control of patient and surgical risk factors -when possible, the proper antimicrobial prophylaxis, and the choice of validated techniques of treatment could contribute to keep DSWIs at a minimal rate. Core tip: Intensivists and cardiothoracic surgeons are commonly worried about surgical site infections due to increasing length of stay, costs, and mortality. In particular, deep sternal wound infection (DSWI) is a worrying complication after cardiac surgery, with a still relevant incidence. Unfortunately, DWSI appearance is related to a wide number of both patient and surgical factors. This review may be useful for guiding physicians to the knowledge of main risk factors and the choice of the appropriate management of DWSIs with the aim of reducing the rate of this potentially devastating complication in cardiac surgery patients.Cotogni P, Barbero C, Rinaldi M. Deep sternal wound infection after cardiac surgery: Evidences and controversies. World J Crit Care Med 2015; 4(4): 265-273 Available from: URL: http:// www.wjgnet.com/2220-3141/full/v4/i4/265.htm DOI: http:// dx.doi.org/10.5492/wjccm.v4.i4.265 INTRODUCTIONDeep sternal wound infection (DSWI) is one of the most complex and potentially devastating complications following median sternotomy in cardiac surgery with a significant impact on both patient prognosis and hospital budgets [1][2][3][4][5] . Despite many advances in prevention, it still remains significant and ranges between 0.5% and 6.8% [6][7][8][9][10] , with in-hospital mortality rates between 7% and 35% [2,3,7,9,[11][12][13] . Moreover, mid-and long-term survival is significantly reduced in patients that have experienced DSWI. By the end of the first year, Filsoufi et al [6] found a 15% absolute survival difference between patients ...

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“…Also similar aggressive primary treatment was reported by Stump Army et al; sternal debridement followed by omentoplasty in diabetes [6]. Nahai et al reported significant reduction in hospital stay following debridement and omental or muscle flap performed in all instances of DSWI [14] Also Jones G et al reported similar finding in management of critical ill patients with sternal wound infection with muscle flaps [7].…”

Section: Discussionmentioning

confidence: 56%

“…It has also been noted that early detection and aggressive treatment were responsible for the reduction in the high mortality previously reported [6,7].…”

Section: Introductionmentioning

confidence: 94%

Sternal wound infection following open heart surgery: appraisal of incidence, risk factors, changing bacteriologic pattern and treatment outcome

Okonta

Mohanraj

Agarwal

et al. 2011

Indian J Thorac Cardiovasc Surg

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Background The incidence of Sternal wound infection as reported worldwide is 0.43-2.3% [1-7]. The incidence is low and has serious effects on the patients in terms of the morbidity, hospital stay, cost as well as mortality. This study proposes to identify the risk factors, changing bacteriologic and the treatment outcomes. Methods 6492 consecutive patients who had median sternotomy for open heart surgery in the adult unit were retrospectively analysed (using SPSS10.0 window software) between

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Omental Transposition Flap for Sternal Wound Reconstruction in Diabetic Patients

Cited by 22 publications

References 23 publications

Management of the extensive thoracic defects after deep sternal wound infection with the rectus abdominis myocutaneous flap

Management of the extensive thoracic defects after deep sternal wound infection with the rectus abdominis myocutaneous flap

Deep sternal wound infection after cardiac surgery: Evidences and controversies

Sternal wound infection following open heart surgery: appraisal of incidence, risk factors, changing bacteriologic pattern and treatment outcome

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