Omental flap harvested through transdiaphragmatic approach at the same sternotomy incision for poststernotomy mediastinitis: a new approach

• Main Author: Waleed El-Awady
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2019-01-01
• Series: Journal of Medicine in Scientific Research
• Subjects: omental flap; poststernotomy mediastinitis; the same sternotomy incision; transdiaphragmatic approach
• Online Access: http://www.jmsr.eg.net/article.asp?issn=2537-091X;year=2019;volume=2;issue=4;spage=319;epage=323;aulast=El-Awady
• ISSN: 2537-091X; 2537-0928

Background The surgical treatment of poststernotomy mediastinitis is still a challenge and associated with high mortality. Conservative treatment and various surgical procedures are sometimes inadequate and need more aggressive treatment. Omental flap improves control of infection and prognosis, but harvesting is an additional procedure with its associated morbidity and trauma. Patients and methods A total of 14 patients had omental flap, which was harvested through a diaphragmatic opening at the lower part of the same sternotomy incision, without additional laparotomy incision or extension of sternotomy incision into the upper abdomen or even laparoscopically. The mean age of the patients was 59.5 ± 15.5 years. There were nine females and five males. Coronary artery bypass grafting was done in 12 patients and two patients had mitral valve replacement. Results There were no complications related to the omentoplasty. No herniation of abdominal organ occurred. Reoperation was performed at an interval of 15 days (7–23 days). Wound debridement was done in four patients, and wound was opened in five patients. Two patients had vacuum suction. Tissue cultures revealed staphylococci in eight patients. Omental flap was performed alone in 10 and combined with pectoralis flap in four patients. The operative mortality was one patient. Prolonged ICU stay (±pneumonia) was seen in four patients and prolonged ventilation in four patients. Septicemia was seen in two patients, and one of them died with septic shock. No early or late flap failure occurred. Incisional hernia occurred in one patient and lymphorrhea in one patient. Conclusion Transdiaphragmatic approach which allows harvesting of omental flap safely through the same sternotomy incision is a new era of minimally invasive surgery without the need of additional laparotomy or extension of the sternotomy incision to the upper abdomen or even laparoscopic surgery and provides excellent results for the treatment of poststernotomy mediastinitis through the same sternal incision.