Omentum flap as a salvage procedure in deep sternal wound infection

Abstract

IntroductionDeep sternal wound infections (DSWIs) are rare but devastating complication after median sternotomy following cardiac surgery. Especially in the presence of artificial material or inadequate preliminary muscle flaps, the pedicled omentum flap is due to its immunological properties, the predetermined flap in salvage procedures.MethodsWe treated 14 patients suffering a mediastinitis and open thorax using a pedicled omentoplasty as a salvage procedure because of persisting DSWIs. Omentoplasty was performed in combination with a split skin graft and the wound was closed by a vacuum-assisted therapy for 7 days. The patients’ sex and comorbid risk factors supporting DSWIs as well as the postoperative complications were recorded.ResultsRetrospective analysis of 14 patients (10 males and four females) after a follow-up time of 24 months was performed. The average age was 75 years (range: 67–83). Heart surgery took place electively in eight cases, in three cases urgently and three for emergency reasons. The preoperative Euro Score was 16 (range 3.51–42.58). We had no flap loss in any patients. The skin graft showed a full take in all patients. Two patients needed revision of an abdominal wound dehiscence after laparotomy and one patient developed hernia in the late outcome.DiscussionThe greater omentum flap has, over many years, become an ideal partner in the coverage and treatment of DSWIs. Especially due to its immunologic capacity and amorphous structure, it has the ability to fill up cavities and cover infected artificial material so residual infections can be controlled.

Utilização do retalho de omento na reconstrução torácica: relato de caso

“…Além disso, a flexibilidade e o amplo eixo de rotação o tornam uma opção atraente para o fechamento da ferida esternal, além de possibilitar o preenchimento do espaço morto após o desbridamento agressivo 6,7,9 .…”

Surgical treatment of aortic graft infections

“…В нашем исследовании интервал между первичной операцией и пластикой средостения в среднем составил 50 дней. Это коррелирует с данными немецких ученых, у которых эта цифра равнялась 60 дням (от 18 до 136 дней) [1]. Однако известны случаи поздних ИПА через 20 лет после первичного оперативного вмешательства [25].…”

“…В литературе [1] описаны случаи рецидива или персистенции инфекции после миопластики. В связи с этим многими признаются универсальность и эффективность применения пряди большого сальника для элиминации очага инфекции.…”

Omentum flap as a salvage procedure in deep sternal wound infection

“…We read with great interest the report by Dr Spindler and coworkers about the utilization of omentoplasty as salvage procedure in deep sternal wound infection. 1 First of all, we congratulate the authors on the excellent results. Mortality rates in this high-risk cohort of patients can be attributed to advanced age, comorbidities, and other complications, but neither the timing nor the type of reconstruction performed.…”