| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Ann Thorac Surg 1997;63:859-860
© 1997 The Society of Thoracic Surgeons
Mayo Clinic 200 First St, SW Rochester, MN 55905
The key to successful management of infected sternotomy wounds is adequate debridement, removal of all foreign material, and obliteration of all dead space. The split omental transfer as described by Yoshida and associates is yet another method that is aimed at obliteration of dead space by tissue transposition. Although not previously reported for the management of infected sternotomy wounds, the technique of split omental mobilization is not new. Alday and Goldsmith [1] described manipulation of the omentum based on its own vascular anatomy in 1972, and multiple examples [2] of this technique have existed in the literature since that time. Yoshida and associates' current description is another such example.
Single-pedicle omental transposition has been demonstrated to be effective in management of infected sternotomy wounds [3]. Single-pedicle transposition does, however, have two distinct disadvantages. First, a sterile visceral cavity must be entered to mobilize the omentum, and second, a diaphragmatic hernia is produced when the omentum is passed into the mediastinum posterior to the sternum. Thus, omental transposition runs the distinct risk of both abdominal contamination and herniation. Splitting the omentum and transposing the smaller pedicle above the sternum introduces a third liability, namely, doubling the risk of abdominal herniation by creating a ventral hernia as the omentum passes through the linea alba.
When should split omental transposition be used in infected sternotomy wounds? In general, our preference [3] is to consider all omental transpositions as a backup procedure to bilateral pectoralis major muscle transposition. The vast majority of infected sternotomies in our experience have required a total sternectomy with closure of the wound accomplished by mobilizing and rotating these muscles centrally on the thoracoacrominal vessels and then closing the skin directly. If these muscles are absent or insufficient to obliterate the mediastinum, omental transposition becomes a reasonable second option. It would appear to us that splitting the omentum would have its greatest benefit in those patients who have an intact sternum but who have insufficient soft tissue to close the wound. In these patients passing an omental pedicle both above and below the sternum would both obliterate the mediastinum and provide a bed for a split-thickness skin graft if insufficient soft tissue were present to close the wound. However, if the sternum is completely removed in the course of debridement (a frequent necessity in chronic, fulminant sternal osteomyelitis and suppurative mediastinitis), obliteration of the mediastinal space can be accomplished with a single-pedicle transposition. Closing the wound in this latter situation becomes a nonissue because the mediastinal omentum can be covered directly with a split-thickness skin graft, if needed.
References
Related Article
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
