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J. Maxwell Chamberlain memorial paper. Sternal wound complications after isolated
coronary artery bypass grafting: early and late mortality, morbidity, and cost of
care.
Ann Thorac Surg.1990; 49 (discussion 186–177): 179-186
Due to its large surface area, unsurpassed pliability, and rich blood and lymphatic
supply, the greater omentum has proved to be effective for the reconstruction of large
contaminated spaces, and is now commonly used in the management of sternal wound infection.
The omentum is transposed into the anterior mediastinum either through an incision
in the anterior diaphragm, or through the laparotomy incision and a subcutaneous tunnel.
Although the transdiaphragmatic approach allows for a more direct route with added
length, it has associated complications. A delicate balance exists where the diaphragmatic
defect should be created large enough to accommodate the omental stalk to prevent
pedicle compression, but not so large that gastrointestinal herniation into the chest
is likely.
In our single surgeon experience of 38 cases of omental transposition for deep sternotomy
wound infections using the transdiaphragmatic approach, symptomatic diaphragmatic
hernia occurred in 3 patients (7.9%) (Figure 1). To reduce this risk, we developed a modification where the ligamentum teres was
used to reinforce the diaphragmatic defect.
Figure 1(A) A 64 year old gentleman underwent coronary bypass grafting. On postoperative day
21, a diagnosis of deep sternal wound infection was made. This photograph shows the
open sternal wound following debridement and negative pressure therapy prior to definitive
closure using primary omental transposition flap. (B) Healed sternum and abdomen six
months following omental transposition. (C) Two years after omentoplasty, this gentleman
developed a large diaphragmatic hernia.
J. Maxwell Chamberlain memorial paper. Sternal wound complications after isolated coronary artery bypass grafting: early and late mortality, morbidity, and cost of care.
Ann Thorac Surg.1990; 49 (discussion 186–177): 179-186
