title: Results of omental flap transposition for deep sternal wound infection after cardiovascular surgery.
abstract: OBJECTIVE
  Our experience with omental flap transposition in the treatment of deep sternal wound infections is reviewed here with an emphasis on efficacy, risk factors for in-hospital mortality rates, and long-term results.
  
  
  BACKGROUND
  Even with improvements in muscle and omental flap transposition, the timing of closure and the surgical strategy are controversial.
  
  
  METHODS
  Forty-four consecutive patients with deep sternal wound infections were treated using the omental flap transposition from 1985 through 1994. The strategies included debridement with delayed omental flap transposition or single-stage management, which consisted of debridement of the sternal wound and omental flap transposition. Methicillin-resistant Staphylococcus aureus was cultured from more than 50% of the wounds. A logistic regression analysis was used to identify the predictors of in-hospital death after omental flap transposition.
  
  
  RESULTS
  There were seven (16%) in-hospital deaths. Univariate analysis demonstrated that hemodialysis and ventilatory support at the time of omental flap transposition were significantly associated with in-hospital mortality rates (p = 0.0023 and p = 0.0075, respectively). Thirty-seven patients whose wounds healed well were discharged from the hospital. Two patients with cultures positive for methicillin-resistant Staphylococcus aureus had recurrent sternal infections. Patients without positive methicillin-resistant Staphylococcus aureus cultures had good long-term results after reconstructive surgery.
  
  
  CONCLUSIONS
  Transposition of an omental flap is a reliable option in the treatment of deep sternal wound infections, unless the patients require ventilatory support or hemodialysis at the time of transposition.
authors.affiliation: Department of Thoracic Surgery, Nagoya University School of Medicine, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Yasuura
authors.forename: H
authors.initials: H
authors.lastname: Okamoto
authors.forename: S
authors.initials: S
authors.lastname: Morita
authors.forename: Y
authors.initials: Y
authors.lastname: Ogawa
authors.forename: M
authors.initials: M
authors.lastname: Sawazaki
authors.forename: A
authors.initials: A
authors.lastname: Seki
authors.forename: H
authors.initials: H
authors.lastname: Masumoto
authors.forename: A
authors.initials: A
authors.lastname: Matsuura
authors.forename: T
authors.initials: T
authors.lastname: Maseki
authors.forename: S
authors.initials: S
authors.lastname: Torii
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009852:Omentum / Q000637:transplantation*; D012189:Retrospective Studies; D013249:Sternum; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000209:etiology* / Q000601:surgery*; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*