Der gefäßgestielte Omentumlappen zur Behandlung tiefer sternaler Wundinfekte

Zusammenfassung

Zielsetzung Defektdeckung einer persistierenden, sternalen Wundheilungsstörung, die nach frustranem Deckungsversuch mittels eines gestielten Latissimus-dorsi-Lappens durch eine Omentumplastik zur Ausheilung gebracht wurde.

Indikation Tiefe sternale Wundheilungsstörungen sind seltene, aber schwerwiegende Komplikationen nach medianer Sternotomie. Wenn reguläre Deckungsverfahren fehlschlagen oder nicht zu entfernendes Fremdmaterial wie „Drivelines“ oder Gefäßprothesen mittels Muskellappen nicht zur Ausheilung gebracht werden können, bildet der Omentumlappen, aufgrund seiner immunologischen Kompetenz, eine sinnvolle Alternative.

Methode Nach Exploration des persistierenden, sternalen Defekts schießt sich das radikale tangentiale Débridement und die Spülung der Wunde mittels einer Jet-Lavage an. Das Gewebe des Omentums wird nach Medianlaparotomie und Präparation des Lappens durch einen im vorderen Diaphragma angelegten Tunnel in den Defekt verlagert und kann hier spannungsfrei zur Ummantelung der Prothese verwendet werden. Der im Vorfeld verwendete Latissimuslappen wird in diesem Fall für den oberflächlichen Weichteilverschluss wiederverwendet.

Schlussfolgerung Insbesondere bei infiziertem, nicht entfernbarem Restmaterial stellt der Omentumlappen aufgrund seiner immunologischen Kompetenz eine gute Behandlungsalternative zu Muskellappen dar.

Abstract

Aim Coverage of a deep sternal wound infection with a greater omentum flap. Due to a persistent infection caused by an infected aortic prosthesis, the primarily performed reconstruction with a latissimus dorsi flap had to be revised, and an alternative solution had to be found.

Indication A deep sternal wound infection is a rare but devastating complication following median sternotomy. If the commonly used muscle flap is not sufficient and artificial material is still present in the wound, for instant drivelines or a vascular prosthesis, the greater omentum flap is a useful option due to its immunologic capacity.

Method After an exploration of the persisting infected deep sternal wound, a radical debridement is performed followed by a jet lavage. The soft tissue from the greater omentum is prepared via median laparotomy and transferred through a tunnel created in the diaphragm. Then it is pulled into the wound cavity and can be used for tension-free sheathing of the aortic prosthesis. The previously used muscle flap can additionally be used for superficial soft tissue coverage.

Conclusion Due to its immunologic competence, the greater omentum flap is a good treatment alternative to the commonly used muscle flaps in defects with infected artificial material.

Schlüsselwörter

Omentumlappen - Sternumosteomyelitis - Mediastinitis

Key words

omentum flap - deep sternal wound infection (DSWI) - mediastinitis

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