Transposition of the greater omentum for recalcitrant median sternotomy wound infections

During a 3-year period, 25 patients underwent transposition of the greater omentum, either alone or in combination with muscle flaps, for treatment of recalcitrant median sternotomy wound infections. Most patients underwent radical sternectomy for deep and extensive sternal wounds; the others had significant defects involving the lower third of the sternum. The most common combination of flaps was omentum and bilateral pectoralis major musculocutaneous flaps (14 patients). Delay to reconstruction after the recognition of median sternotomy infection ranged from 2 to 36 days (average, 13.9 days) except for one patient treated outside by the "open method" for 18 months. Definitive closure was performed after an average of 1.8 debridements (range, 1-4). Hospitalization averaged 28.5 days (range, 13-42 days) in 16 of the 19 surviving patients. The majority of these patients had far more extensive sternal defects than those usually treated by muscle flaps alone. Healing was ultimately achieved in 95% of infected sternotomy wounds. Seventy-four percent of patients healed their sternal wounds uneventfully without subsequent problems. Flap site complications in the remaining patients included recurrent chondritis (16%) and partial (4%) or complete (4%) flap loss. Donor-site complications included abdominal wall herniation (21%), hematoma (8%), and seroma (4%). There were no problems with chest wall instability or intra-abdominal morbidity. Six patients (24%) succumbed to multisystem failure unrelated to sternal infection. We present our experience--including indications, technique, and outcome--with transposition of the greater omentum for recalcitrant median sternotomy wound infections.(ABSTRACT TRUNCATED AT 250 WORDS)