Omental flap for recurrent deep sternal wound infection and mediastinitis after cardiac surgery

Aims: Therapy failure after surgical treatment of deep sternal wound infection (DSWI) and postcardiotomy mediastinitis may lead to sepsis, multi-organ failure and death. Seeding of suture lines may produce dehiscence, a life threatening complication. Omental flap transposition (OFT) may be in this situation the „ultima ratio“ therapy.

Methods: Twenty-seven patients with DSWI and postcardiotomy mediastinitis after one or more unsuccessful surgical attempts to cure the infection were treated by OFT. Multi resistant organisms were responsible for the infection in 11 patients (40.7%). A total of 41 interventions (1.5 pro patient) consisting of closed irrigation technique, bilateral pectoralis flap reconstruction and vacuum-assisted therapy were performed to treat DSWI before OFT was used.

Results: OFT was performed on average at 137 days after the initial cardiac surgery. Mean procedure time was 224min. Mean postoperative ventilation time was 1.38 days and mean time in the intensive care unit was 4.7 days. Hospital mortality was 7.4% (2 patients). Cause of death was sepsis and multi organ failure. Mean follow-up time was 2 years. One patient (4%) died one year after discharge. During follow-up abdominal wall hernia occurred in one patient (4%) and presternal fistula resection was necessary in another patient (4%). There were no other late complications related to OFT.

Conclusions: OFT is in our experience the most effective procedure for treatment of recurrent DSWI and mediastinitis after cardiac surgery. Early mortality is acceptable, morbidity is low and late results are very good.