Omental flap for recurrent deep sternal wound infection and mediastinitis after cardiac surgery.
BACKGROUND
Unsuccessful surgical treatment of deep sternal wound infection (DSWI) and mediastinitis may lead to sepsis, multiorgan failure and death. Omental flap transposition (OFT) may, in this situation, be the only effective therapy.


METHODS
Twenty-seven patients with DSWI and mediastinitis after one or more unsuccessful surgical attempts to cure the infection were treated by OFT. Forty-one interventions (1.5/patient) consisting of closed irrigation technique, bilateral pectoralis flap reconstruction and vacuum-assisted therapy were performed before carrying out OFT.


RESULTS
Operative mortality was 0. Mean postoperative ventilation time was 1.38 days and mean time in the intensive care unit was 4.7 days. Hospital mortality was 7.4 % (n = 2). Mean follow-up time was 2 years. One patient (4 %) died one year after discharge. During follow-up, abdominal wall hernia occurred in one patient (4 %) and presternal fistula resection was necessary in another patient (4 %).


CONCLUSIONS
OFT is, in our experience, the most effective procedure for the treatment of recurrent DSWI and mediastinitis after cardiac surgery. Early mortality is acceptable, morbidity is low and late results are very good.
Eifert
S
S
Department of Cardiac Surgery, Grosshadern Medical Center, Ludwig-Maximilians-University Munich, Germany.
Kronschnabl
S
S
Kaczmarek
I
I
Reichart
B
B
Vicol
C
C
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D009852:Omentum / Q000637:transplantation*; D012008:Recurrence; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D013249:Sternum; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing
D000900:Anti-Bacterial Agents