Omental transposition: the final solution for major sternal wound infection.
Sternal osteomyelitis after median sternotomy for cardiac surgery is associated with considerable morbidity and mortality. The ideal reconstruction after sternal debridement is still debated. From 2000 to 2004, we treated 15 patients for sternal osteomyelitis (type IIIB, IVA, IVB) after median sternotomy for cardiac surgery. Total or partial resection of the sternum and extensive debridement were performed in all cases. The defect was covered by omental transposition. In 11 cases, a single-stage operation took place, and a two-stage procedure was employed in 4. All patients had antibiotics postoperatively. There were 3 (20%) deaths due to cardiac failure. Hospital stay ranged from 21 to 45 days. Transient paradoxical movement of the anterior chest wall disappeared within one month. No recurrence was observed during 6 to 24 months of follow-up. Radical debridement along with omental flap transposition provides definitive control of the infection in cases of failure of other semi-conservative or surgical interventions. Prognosis depends on the general condition of the patient.
Athanassiadi
Kalliopi
K
1st Department of Thoracic Surgery, General Hospital for Chest Diseases, Athens, Greece. kallatha@otenet.gr
Theakos
Nick
N
Benakis
Georgios
G
Kakaris
Stamatis
S
Skottis
Ion
I
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008480:Mediastinitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D009852:Omentum / Q000601:surgery*; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D013249:Sternum / Q000601:surgery*; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents