K. Yasuura et al., RESULTS OF OMENTAL FLAP TRANSPOSITION FOR DEEP STERNAL WOUND-INFECTION AFTER CARDIOVASCULAR-SURGERY, Annals of surgery, 227(3), 1998, pp. 455-459
Objective Our experience with omental flap transposition in the treatm
ent of deep sternal wound infections is reviewed here with an emphasis
on efficacy, risk factors for in-hospital mortality rates, and long-t
erm results. Summary Background Data Even with improvements in muscle
and omental flap transposition, the timing of closure and the surgical
strategy are controversial. Methods Forty-four consecutive patients w
ith deep sternal wound infections were treated using the omental flap
transposition from 1985 through 1994, The strategies included debridem
ent with delayed omental flap transposition or single-stage management
, which consisted of debridement of the sternal wound and omental flap
transposition, Methicillin-resistant Staphylococcus aureus was cultur
ed from more than 50% of the wounds. A logistic regression analysis wa
s used to identify the predictors of in-hospital death after omental f
lap transposition. Results There were seven (16%) in-hospital deaths.
Univariate analysis demonstrated that hemodialysis and ventilatory sup
port at the time of omental flap transposition were significantly asso
ciated with in-hospital mortality rates (p = 0.0023 and p = 0.0075, re
spectively). Thirty-seven patients whose wounds healed well were disch
arged from the hospital. Two patients with cultures positive for methi
cillin-resistant Staphylococcus aureus had recurrent sternal infection
s, Patients without positive methicillin-resistant Staphylococcus aure
us cultures had good long-term results after reconstructive surgery. C
onclusions Transposition of an omental flap is a reliable option in th
e treatment of deep sternal wound infections, unless the patients requ
ire ventilatory support or hemodialysis at the time of transposition.