Results of Omental Flap Transposition for Deep Sternal Wound Infection After Cardiovascular Surgery

Abstract

Our experience with omental flap transposition in the treatment of deep sternal wound infections is reviewed here with an emphasis on efficacy, risk factors for in-hospital mortality rates, and long-term results. Even with improvements in muscle and omental flap transposition, the timing of closure and the surgical strategy are controversial. Forty-four consecutive patients with deep sternal wound infections were treated using the omental flap transposition from 1985 through 1994. The strategies included debridement 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 cultured from more than 50% of the wounds. A logistic regression analysis was used to identify the predictors of in-hospital death after omental flap transposition. There were seven (16%) in-hospital deaths. Univariate analysis demonstrated that hemodialysis and ventilatory support at the time of omental flap transposition were significantly associated with in-hospital mortality rates (p = 0.0023 and p = 0.0075, respectively). Thirty-seven patients whose wounds healed well were discharged from the hospital. Two patients with cultures positive for methicillin-resistant Staphylococcus aureus had recurrent sternal infections. Patients without positive methicillin-resistant Staphylococcus aureus cultures had good long-term results after reconstructive surgery. Transposition of an omental flap is a reliable option in the treatment of deep sternal wound infections, unless the patients require ventilatory support or hemodialysis at the time of transposition.