Multisegmental Omental and Pectoralis Flaps for Sternal Wound Reconstruction

Sternal wound infections are a serious complication after cardiac surgery and are associated with significant morbidity and mortality. Deep sternal wound infections are characterized by positive mediastinal cultures, clinical signs of mediastinitis, and symptoms such as fever, sternal instability, or purulent drainage. Management includes serial debridement, negative pressure wound therapy, and definitive reconstruction. We present a 70-year-old man with a history of aortic and mitral valve disease, diabetes, chronic kidney disease, and bladder cancer who underwent prosthetic aortic graft reconstruction (Bentall procedure). Postoperatively, he developed mediastinitis requiring multiple washouts and wound vacuum-assisted closure therapy. For reconstruction, a split omental flap pedicled on the right gastroepiploic artery was mobilized, with 1 segment covering the aortic graft and the other the lower sternum. SPY angiography was used to determine the site of division. Sternal closure was performed with wires. Bilateral pectoralis major flaps were advanced medially to complete upper third sternal coverage. This case demonstrates the feasibility of a combined split omental and bilateral pectoralis flap reconstruction for complex deep sternal wound infection, providing layered, vascularized coverage over grafts and bone. This report underscored the viability and utility of a multisegmental omental flap in combination with pectoralis flaps for deep and superficial sternal wounds following cardiothoracic surgery.