Distinct Roles of Omental and Latissimus Dorsi Flaps for Blocking Infection Pathways and Protecting A Left Ventricular Assist Device
DOI:
https://doi.org/10.59958/hsf.7905Keywords:
omentum, LVAD, exposureAbstract
Left ventricular assist devices (LVADs) are vital for managing severe heart failure in transplant-ineligible patients, but device exposure and infection pose significant challenges. This report details a 42-year-old man with dilated cardiomyopathy and bronchial asthma who presented with an externalized LVAD following a HeartMate II to HeartMate III exchange due to malfunction. Our tailored surgical strategy treated the LVAD driveline and main body as two distinct parts. This distinction is crucial, as major upstream infections typically originate from the driveline. We applied flaps to these parts for different purposes, maximizing their unique characteristics. The omental flap, chosen for its flexibility, blood supply, and immunological activation upon foreign body contact, covered the driveline. The latissimus dorsi flap provided vascularity and mechanical protection for the LVAD. Additionally, we review the omentum's basic physiological aspects, which are often unfamiliar to clinicians. Infection has not recurred in 6 months postoperatively, demonstrating the approach's effectiveness.
References
Crespo-Leiro MG, Costanzo MR, Gustafsson F, Khush KK, Macdonald PS, Potena L, et al. Heart transplantation: focus on donor recovery strategies, left ventricular assist devices, and novel therapies. European Heart Journal. 2022; 43: 2237–2246.
Iglesias-Álvarez D, Pathania V. LVAD as a bridge to decision complicated with pump thrombosis and infection. Indian Journal of Thoracic and Cardiovascular Surgery. 2021; 37: 341–344.
Long B, Robertson J, Koyfman A, Brady W. Left ventricular assist devices and their complications: A review for emergency clinicians. The American Journal of Emergency Medicine. 2019; 37: 1562–1570.
Sajjadian A, Valerio IL, Acurturk O, Askari MA, Sacks J, Kormos RL, et al. Omental transposition flap for salvage of ventricular assist devices. Plastic and Reconstructive Surgery. 2006; 118: 919–926.
Copeland H, Baran D. A persistent problem-The dreaded LVAD driveline infection. Journal of Cardiac Surgery. 2022; 37: 105–106.
Cikirikcioglu M, Ponchant K, Murith N, Meyer P, Yilmaz N, Huber C. Treatment of HeartMate III-LVAD driveline infection by negative pressure wound therapy: Result of our case series. The International Journal of Artificial Organs. 2021; 44: 912–916.
Clark RC, Swanson MA, Cai Y, Sarode AL, Lineberry KD, Kumar AR. Threatened Ventricular Assist Devices: Meta-analysis of Negative Pressure Therapy and Flap Reconstruction Outcomes. Plastic and Reconstructive Surgery. Global Open. 2022; 10: e4627.
Takayama Y, Yokoo S, Makiguchi T, Komori T. Motor Nerve Preservation and Muscle Atrophy After Pectoralis Major Musculocutaneous Flap Surgery for Oromandibular Reconstruction. The Journal of Craniofacial Surgery. 2016; 27: 2055–2060.
Seder CW, Rocco G. Chest wall reconstruction after extended resection. Journal of Thoracic Disease. 2016; 8: S863–S871.
Jo GY, Ki SH. Analysis of the Chest Wall Reconstruction Methods after Malignant Tumor Resection. Archives of Plastic Surgery. 2023; 50: 10–16.
Schulte-Eistrup S, Reiss N, Schmidt T, Billion M, Schmitto JD, Warnecke H. Greater Omentum Wrapping to Treat Systemic Ventricular Assist Device Infections. Operative Techniques in Thoracic and Cardiovascular Surgery. 2017; 22: 186–197.
Polycarpou A, Pahwa S, Blackmon SH, Stulak JM. Novel Innovations for Ventricular Assist Device Infection. ASAIO Journal (American Society for Artificial Internal Organs: 1992). 2021; 67: e221–e223.
Litbarg NO, Gudehithlu KP, Sethupathi P, Arruda JAL, Dunea G, Singh AK. Activated omentum becomes rich in factors that promote healing and tissue regeneration. Cell and Tissue Research. 2007; 328: 487–497.
Sivaratnam K, Duggan JM. Left ventricular assist device infections: three case reports and a review of the literature. ASAIO Journal (American Society for Artificial Internal Organs: 1992). 2002; 48: 2–7.
Lee ZH, Abdou SA, Daar DA, Anzai L, Stranix JT, Thanik V, et al. Comparing Outcomes for Fasciocutaneous versus Muscle Flaps in Foot and Ankle Free Flap Reconstruction. Journal of Reconstructive Microsurgery. 2019; 35: 646–651.
Salgado CJ, Mardini S, Jamali AA, Ortiz J, Gonzales R, Chen HC. Muscle versus nonmuscle flaps in the reconstruction of chronic osteomyelitis defects. Plastic and Reconstructive Surgery. 2006; 118: 1401–1411.
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