Omental pedicle grafting in the treatment of poststernotomy mediastinitis

Mediastinitis after median sternotomy may be life-threatening. It should be managed by providing adequate mediastinal drainage, removing all foreign material (including infected and dead tissues) and obliterating any dead space. Obliterating dead space may be difficult using the usual method of creating a vacuum with large-bore tubes. Alternative methods consist of muscle or omental transpositions. The authors describe the cases of two men who had mediastinitis, 1 week and 3 months respectively, after coronary artery bypass grafting. In both cases, the mediastinitis was treated successfully by omental pedicle grafting. From their experience, the authors recommend omental grafting as a method of obliterating a large mediastinal dead space when the sternal edges can be approximated but the space cannot be closed by conventional methods.