title: Laparoscopic harvest of an omental flap to reconstruct an infected sternotomy wound.
abstract: Sternotomy dehiscence is associated with a high mortality rate. In most cases this complication may be treated by simple debridement and antibiotic therapy, but sometimes it is necessary to fill the sternal defect with viable tissue. The greater omentum seems to be the ideal tissue to be transposed because of its malleability, good vascularization, and high lymphatic tissue content. The transposition of the greater omentum usually requires a midline laparotomy for the preparation of the flap, with significant laparotomy-related morbidity. Laparoscopic access may represent an effective alternative for preparing and transposing the omental flap. The key points of the laparoscopic technique are (1) the coloepiploic detachment, (2) the section of the anastomotic arterial branches between the Barkow's arcade and the gastroepiploic arcade, (3) the mobilization of the greater omentum pedicled on the right gastroepiploic artery, and (4) its transposition into the mediastinum, taking care to avoid twisting the gastric greater curvature and the flap itself.
authors.affiliation: Laparoendoscopic Unit, Aurelia Hospital, Rome, Italy. gtebala@alice.it
authors.forename: Giovanni Domenico
authors.initials: GD
authors.lastname: Tebala
authors.forename: Renzo
authors.initials: R
authors.lastname: Ciani
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Fonsi
authors.forename: Hossein
authors.initials: H
authors.lastname: Hadjiamiri
authors.forename: Paolo
authors.initials: P
authors.lastname: Barone
authors.forename: Pietro
authors.initials: P
authors.lastname: Di Pietrantonio
authors.forename: Antonella
authors.initials: A
authors.lastname: Zumbo
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009852:Omentum / Q000637:transplantation*; D013249:Sternum / Q000601:surgery*; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000601:surgery*