title: Management of thoracic aortic graft infections with the omental flap.
abstract: BACKGROUND
  Infection of thoracic aortic grafts occurs infrequently; however, once present, it is associated with high patient morbidity and mortality. We report our successful experience in the treatment of 11 patients who developed infection of their thoracic aortic graft.
  
  
  METHODS
  This is an institutional review board-approved retrospective review of 11 patients who had documented thoracic aortic graft infections with associated mediastinitis or empyema. After diagnosis, plastic surgery consultation was obtained, and the patients underwent formal operative debridement with cardiovascular service. Intraoperative cultures were obtained, and the patients were placed on specific antibiotic regimens. After the wound bed was adequately prepared, the omentum was harvested and was based on the right gastroepiploic vessels. The flap was circumferentially wrapped around the aortic graft and simultaneously used to fill the mediastinal dead space. In a certain subset of patients, a cryopreserved homograft replaced the synthetic graft before omental flap reconstruction.
  
  
  RESULTS
  The infections were eventually controlled in all surviving patients. Ten of 11 patients were discharged either to a rehab or to a nursing facility. There was 1 perioperative death secondary to multisystem organ failure. Mean follow-up period was 36 months and revealed a greater than 90% survival rate. Serial imaging reported no suture-line complications.
  
  
  CONCLUSIONS
  We report our series on the treatment of patients with infection of thoracic aortic grafts. Debridement and tissue coverage with an omental flap provided these patients with successful recovery and survival.
authors.affiliation: Institute of Reconstructive Plastic Surgery, New York University Medical Center, New York, NY, USA. sammy.sinno@nyumc.org
authors.forename: Samir
authors.initials: S
authors.lastname: Shah
authors.forename: Sammy
authors.initials: S
authors.lastname: Sinno
authors.forename: Darl
authors.initials: D
authors.lastname: Vandevender
authors.forename: Jeffery
authors.initials: J
authors.lastname: Schwartz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001013:Aorta, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D003131:Combined Modality Therapy; D016724:Empyema, Pleural / Q000188:drug therapy / Q000209:etiology / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000188:drug therapy / Q000209:etiology / Q000401:mortality / Q000601:surgery; D008875:Middle Aged; D009852:Omentum / Q000601:surgery*; D016459:Prosthesis-Related Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D013524:Surgical Flaps; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents