title: Transdiaphragmatic omental harvest: a simple, efficient method for sternal wound coverage.
abstract: BACKGROUND
  The greater omentum is easily harvested for coverage of sternal wounds without muscle sacrifice. Its major disadvantage is a laparotomy incision with potential bowel injury, adhesions, or hernia. Over the past 20 years, the authors' technique has evolved to use a transdiaphragmatic opening for omental harvest when possible.
  
  
  METHODS
  The authors performed a retrospective cohort analysis of 140 consecutive patients undergoing omental flap harvest for treatment of sternal wounds following median sternotomy. Patients were divided into two groups by access incision: laparotomy incision (n = 80) versus a transdiaphragmatic opening (n = 60).
  
  
  RESULTS
  The authors found that both techniques provided reliable closure of sternal wounds, but the transdiaphragmatic approach was faster, with less blood loss. There was no significant difference in rates of ventral hernias. We had only one bowel injury (laparotomy group) and no postoperative abdominal bleeding or small bowel obstruction.
  
  
  CONCLUSIONS
  Transdiaphragmatic omental harvest provides safe and efficient coverage of deep sternal wounds without a laparotomy incision.
authors.affiliation: Boston, Mass. From the Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School.
authors.forename: Raj M
authors.initials: RM
authors.lastname: Vyas
authors.forename: Adnan
authors.initials: A
authors.lastname: Prsic
authors.forename: Dennis P
authors.initials: DP
authors.lastname: Orgill
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003964:Diaphragm; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009852:Omentum / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D056346:Sternotomy; D020858:Tissue and Organ Harvesting / Q000379:methods*; D058106:Wound Closure Techniques