title: Laparoscopic omental flap for the treatment of major sternal wound infection after cardiac surgery.
abstract: BACKGROUND
  The ideal reconstructive procedure after sternal debridement is still a matter of debate. The omentum might be theoretically preferable for its favorable properties, but it is seldom used because it entails the added trauma of a laparotomy.
  
  
  METHODS
  Three female patients with severe osteomyelitis after myocardial revascularization underwent sternal debridement and filling of the defect with a laparoscopically prepared omental flap. Sternal wound closure was achieved as a single-stage procedure in 2 patients. The third patient had a poststernotomy septicemia and required a 2-stage procedure. The abdominal procedures were conducted through 3 operating 5-mm ports. Omental flaps were developed by complete separation from the transverse colon and lengthening by division of some anastomosing arteries between gastroepiploic vessels and Barkow's arcade. Thoracic transposition of the omentum was achieved through a 5-cm diaphragmatic incision. The flaps were able to reach the base of the neck and fill the sternal defect in all patients.
  
  
  RESULTS
  A smooth postoperative course was observed. Oral intake was started from day 2; sole oral nutrition was maintained from day 3 or 4. Optimal wound healing was observed with minimal or absent local discomfort. Minor transient paradoxical movements of the anterior chest wall disappeared within 1 month. Postoperative hospital stay was 9, 14, and 14 days, respectively.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Thoracic Surgery, Terni, Italy. francescopuma@aospterni.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Puma
authors.forename: Costanzo
authors.initials: C
authors.lastname: Fedeli
authors.forename: Paolo
authors.initials: P
authors.lastname: Ottavi
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Porcaro
authors.forename: Giovanni
authors.initials: G
authors.lastname: Battista Fonsi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pardini
authors.forename: Giuliano
authors.initials: G
authors.lastname: Daddi
mesh_terms: D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003646:Debridement; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D009852:Omentum / Q000637:transplantation; D010019:Osteomyelitis / Q000209:etiology / Q000601:surgery*; D018805:Sepsis / Q000209:etiology / Q000628:therapy; D013249:Sternum / Q000601:surgery*; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000601:surgery*