Utility of Omentoplasty in Mediastinitis Treatment following Sternotomy

  • Abdurrahim Colak Department of Cardiovascular Surgery, Ataturk University, Erzurum,
  • Ugur Kaya Department of Cardiovascular Surgery, Ataturk University, Erzurum,
  • Münacettin Ceviz Department of Cardiovascular Surgery, Ataturk University, Erzurum,
  • Necip Becit Department of Cardiovascular Surgery, Ataturk University, Erzurum,
  • Fehimcan Sevil Department of Cardiovascular Surgery, Ataturk University, Erzurum,
  • Hikmet Kocak Department of Cardiovascular Surgery, Ataturk University, Erzurum,

Abstract

Background: Mediastinal infection is one of the most serious complications that occurs following open-heart surgery by sternotomy. In the present study, omentoplasty was initially and aggressively used to treat the infection and prevent the recurrence caused by bones in cases of mediastinitis following open-heart surgery at our clinic.
Methods: Among the 3656 patients who underwent surgery at our department of cardiovascular surgery between January 1996 and December 2012, omentoplasty as a treatment for mediastinitis was applied to 19 (0.51%) patients (of which 13 were males) following sternotomy. The cases were revised on the 15th day following the first surgery and/or when there was a suspicion of mediastinal infection. The necrotic skin, subcutaneous tissue, and bone tissue were resected, and all the affected sternal tissues were removed until healthy hemorrhagic areas were reached.
Results: The average age of the patients was between
49 and 81 years (mean: 65.7 ± 10.5 years). The mean age of the men was 66.08 ± 12.7 years (age range: 49-81 years) and that of the women was 63.2 ± 6.8 years (age range: 55-71 years). The male to female ratio was 2:1, and in both the male and female groups, the approximate age ranged from 55 and 70 years. In the intraoperative cultures received from wound cases, the most common agent of infection was methicillin-resistant coagulase-negative staphylococci. Purulent leaks from eight patients stopped in approximately 4 days. Purulent leaks from the other 11 patients continued until the 6th day, and thus, medical dressing also continued, after which the leaks stopped on the 15th day. The approximate postoperative hospital stay was 32 days (range: 13-63 days).
Conclusion: Omentoplasty in heart surgery can be considered an effective method when used to control infection and treat secondary poststernotomy mediastinitis.

Author Biographies

Abdurrahim Colak, Department of Cardiovascular Surgery, Ataturk University, Erzurum,
Department of Cardiovascular surgery
Ugur Kaya, Department of Cardiovascular Surgery, Ataturk University, Erzurum,
Department of Cardiovascular surgery
Münacettin Ceviz, Department of Cardiovascular Surgery, Ataturk University, Erzurum,
Department of Cardiovascular surgery

References

Allie DE, Hebert CJ, Lirtzman MD, et al. 2004. Novel treatment strategy for leg and sternal wound complications after coronary artery bypass graft surgery: bioengineered Apligraf. Ann Thorac Surg 78:673-8.

Brandt C, Álvarez JM. 2002. First-line treatment of deep sternal infection by a plastic surgical approach: superior results compared with conventional cardiac surgical orthodoxy. Plast Reconstr Surg 109:2231-7.

Braxton JH, Marrin CA, McGrath PD, et al. 2000. Northern New England cardiovascular disease study group. Ann Thorac Surg 70:2004-7.

Gummert JF, Barten MJ, Hans C, et al. 2002. Mediastinitis and cardiac surgery--an updated risk factor analysis in 10,373 consecutive adult patients. Thorac Cardiovasc Surg 50:87-91.

Hultman CS, Carlson GW, Losken A, et al. 2002. Utility of the omentum in the reconstruction of complex extraperitoneal wounds and defects: donor-site complications in 135 patients from 1975 to 2000. Ann Surg 235:782-95.

Jones G, Jurkiewicz MJ, Bostwick J, et al. 1997. Management of the infected median sternotomy wound with muscle flaps. The Emory 20-year experience. Ann Surg 225:766-78.

Krabatsch T, Fleck E, Hetzer R. 1995. Treating poststernotomy mediastinitis by transposition of the greater omentum: late angiographic findings. J Card Surg 10:46-51.

Lappa A, Malpieri MR, Cicco M, et al. 2003. An alternative inexpensive treatment for deep sternal wound infections after sternotomy. Interac Cardiovasc Thorac Surg 2:629-32.

López-Monjardin H, de la Peña-Salcedo A, Mendoza-Muñoz M, López-Yáñez de la Peña A, Palacio-López E, López-García A. 1998. Omentum flap versus pectoralis major flap in the treatment of mediastinitis. Plast Reconstr Surg 101:1481-5.

O’Shaughnessy L. 1937. Surgical treatment of cardiac ischaemia. Lancet 1:185.

Schroeyers P, Wellens F, Degrieck I, et al. 2001. Aggressive primary treatment for poststernotomy acute mediastinitis: our experience with omental- and muscle flaps surgery. Eur J Cardiothorac Surg 20:743-6.

Thompson SA, Pollock B. 1945. The use of free omental grafts in the thorax: an experimental study. Am J Surg 70:227.

Zhang QX, Magovern CJ, Mack CA, Budenbender KT, Ko W, Rosengart TK. 1997. Vascular endothelial growth factor is the major angiogenic factor in omentum: mechanism of the omentum-mediated angiogenesis. J Surg Res 67:147-54.

Published
2016-12-01
Section
Articles