Laparoscopic harvest of omental flaps for reconstruction of complex mediastinal wounds.
BACKGROUND
Omental harvest for complex poststernotomy mediastinal wounds has traditionally required a formal laparotomy in often high-risk patients, thus making it the procedure of last resort.


METHODS
The charts of all patients who underwent a laparoscopic omental harvest at the Texas Endosurgery Institute were retrospectively reviewed.


RESULTS
Seven patients, 4 males and 3 females with an average age of 65.1 +/- 6.3 years, with complex mediastinal wounds following coronary artery bypass grafting were studied. All patients underwent laparoscopic harvest of omental flaps based on the right gastroepiploic artery (3), the left gastroepiploic artery (1) or both (3), along with pectoralis major myocutaneous advancement flaps in 5 patients and partial-thickness skin graft and a vacuum-assisted closure device in 2 patients. The average operative time for the entire procedure was 196 +/- 54 minutes. Enteric feedings could be tolerated early postoperatively with a mean of 3.8 days. One death (14.2%) occurred. All surviving patients had excellent wound healing results at a mean follow-up of 19.1 months.


CONCLUSIONS
Laparoscopic harvest of omental flaps for the reconstruction of complex mediastinal wounds is a valid and potentially less morbid alternative for the treatment of this infrequent but disastrous complication of open heart surgery.
Salameh
Jihad R
JR
Baylor College of Medicine, Houston, Texas, USA.
Chock
Deborah A
DA
Gonzalez
John J
JJ
Koneru
Suresh
S
Glass
Jeffrey L
JL
Franklin
Morris E
ME
D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008480:Mediastinitis / Q000601:surgery*; D008875:Middle Aged; D009852:Omentum / Q000098:blood supply / Q000601:surgery*; D012189:Retrospective Studies; D013249:Sternum / Q000382:microbiology / Q000601:surgery; D013524:Surgical Flaps / Q000098:blood supply*; D013529:Surgical Wound Dehiscence / Q000601:surgery; D013530:Surgical Wound Infection / Q000601:surgery*; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014945:Wound Healing / Q000502:physiology