Laparoscopic harvest of omental flaps for reconstruction of complex mediastinal wounds

Omental harvest for complex poststernotomy mediastinal wounds has traditionally required a formal laparotomy in often high-risk patients, thus making it the procedure of last resort. The charts of all patients who underwent a laparoscopic omental harvest at the Texas Endosurgery Institute were retro...

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Bibliographic Details
Published in:Journal of the Society of Laparoendoscopic Surgeons 2003-10, Vol.7 (4), p.317-322
Main Authors: Salameh, Jihad R, Chock, Deborah A, Gonzalez, John J, Koneru, Suresh, Glass, Jeffrey L, Franklin, Jr, Morris E
Format: Article
Language:English
Subjects:
Aged
Coronary Artery Bypass - adverse effects
Female
Humans
Laparoscopy - methods
Male
Mediastinitis - surgery
Middle Aged
Omentum - blood supply
Omentum - surgery
Retrospective Studies
Scientific Papers
Sternum - microbiology
Sternum - surgery
Surgical Flaps - blood supply
Surgical Wound Dehiscence - surgery
Surgical Wound Infection - surgery
Tissue and Organ Harvesting - methods
Wound Healing - physiology
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Summary:Omental harvest for complex poststernotomy mediastinal wounds has traditionally required a formal laparotomy in often high-risk patients, thus making it the procedure of last resort. The charts of all patients who underwent a laparoscopic omental harvest at the Texas Endosurgery Institute were retrospectively reviewed. Seven patients, 4 males and 3 females with an average age of 65.1 +/- 6.3 years, with complex mediastinal wounds following coronary artery bypass grafting were studied. All patients underwent laparoscopic harvest of omental flaps based on the right gastroepiploic artery (3), the left gastroepiploic artery (1) or both (3), along with pectoralis major myocutaneous advancement flaps in 5 patients and partial-thickness skin graft and a vacuum-assisted closure device in 2 patients. The average operative time for the entire procedure was 196 +/- 54 minutes. Enteric feedings could be tolerated early postoperatively with a mean of 3.8 days. One death (14.2%) occurred. All surviving patients had excellent wound healing results at a mean follow-up of 19.1 months. Laparoscopic harvest of omental flaps for the reconstruction of complex mediastinal wounds is a valid and potentially less morbid alternative for the treatment of this infrequent but disastrous complication of open heart surgery.
ISSN:1086-8089
1938-3797