Early management of deep sternal wound infections using omental flaps

Background

Deep sternal wound infections (DSWI) are a grave complication that occurs in 0.3%–5% of post-sternotomy patients. In the meantime, there is no consensus over the most appropriate surgical management for sternal wound infections, following open heart surgery. In this retrospective study, we aimed to evaluate the early versus late use of omental-flaps for DSWI and mediastinitis.

Methods

This retrospective study included patients with DSWI following open cardiac surgeries with variable risk factors, degrees of infection and timing of management. The omental-flap was obtained from the greater omentum and transposed into the pleural cavity through a diaphragmatic incision.

Results

Out of the 15 enrolled patients, seven (46.6%) were diabetics and eight (53.3%) had chronic obstructive pulmonary disease. The severe form of mediastinitis occurred with gram-negative infections due to endotoxemia, as well as with resistant infections as methicillin-resistant staph aureus. Eleven patients had a primary omental-flap coverage after debridement (group I), while the other four underwent sternal rewiring, followed by omental-flap coverage (group II). Only three patients (27.2%) in group I died post-operatively, compared to four patients (100%) in group II. Among group I patients, eight had an early omental-flap coverage (IA), while three had a late coverage (IB). Only two patients died after early management, while five out of the seven (71.4%) patients (groups IB and II) died.

Conclusions

Early management of mediastinitis through omental-flaps has a better prognosis than rewiring. This should include a high index of clinical suspicion and a close post-operative follow-up of clinical manifestations.