- 作者：Francesco Puma ; Costanzo Fedeli ; Paolo Ottavi ; Giuseppina Porcaro ; Giovanni Battista Fonsi ; Aless ; ro Pardini ; Giuliano Daddi
- 关键词：Author Keywords ; 5 ; 18 ; 28
- 刊名：The Journal of Thoracic and Cardiovascular Surgery
- 出版年：2003
- 出版时间：December 2003
- 年：2003
- 卷：126
- 期：6
- 页码：1998-2002
- 全文大小：134 K
Methods
Three female patients with severe osteomyelitis after myocardial revascularization underwent sternal debridement and filling of the defect with a laparoscopically prepared omental flap. Sternal wound closure was achieved as a single-stage procedure in 2 patients. The third patient had a poststernotomy septicemia and required a 2-stage procedure. The abdominal procedures were conducted through 3 operating 5-mm ports. Omental flaps were developed by complete separation from the transverse colon and lengthening by division of some anastomosing arteries between gastroepiploic vessels and Barkow’s arcade. Thoracic transposition of the omentum was achieved through a 5-cm diaphragmatic incision. The flaps were able to reach the base of the neck and fill the sternal defect in all patients.
Results
A smooth postoperative course was observed. Oral intake was started from day 2; sole oral nutrition was maintained from day 3 or 4. Optimal wound healing was observed with minimal or absent local discomfort. Minor transient paradoxical movements of the anterior chest wall disappeared within 1 month. Postoperative hospital stay was 9, 14, and 14 days, respectively.
Conclusions
Laparoscopic omentoplasty, compared with the open procedure, entails several advantages for the treatment of sternal osteomyelitis. The introduction of minimally invasive techniques may widen the indications for the use of the omentum in the treatment of major sternal wound infections.