RESULTS OF OMENTAL FLAP TRANSPOSITION FOR DEEP STERNAL WOUND-INFECTION AFTER CARDIOVASCULAR-SURGERY

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.