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Laparoscopically harvested omental flaps for deep sternal wound infection after median sternotomy : A case report Yuki IKEGAYA 1 1Department of Cardiovascular Surgery, Shonan Kamakura General Hospital Keyword: 胸骨感染 , 大網 , 腹腔鏡 pp.637-643
Published Date 2018/9/15
DOI https://doi.org/10.11477/mf.4426200604
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 A 74-year-old male underwent mitral valve replacement through median resternotomy for hemolytic anemia due to mitral valve stenosis after mitral valve reconstruction, tricuspid valve annuloplasty and coronary artery bypass using the left internal thoracic artery. The patient developed deep sternal wound infection. The wound was fully opened and prepared with negative pressure wound therapy following adequate debridement and irrigation. After negative culture from the wound was confirmed, a pedicled omental flap based on the right gastroepiploic artery was harvested laparoscopically. The wound and the anterior mediastinum were filled with the omental flap, and the skin was closed. The wound was well-healed without recurrent wound infections. Deep sternal wound infection remains one of the most serious complications in patients who undergo median sternotomy. The condition may require flap reconstruction to close the wound. Especially, the omental flap has the advantage of adapting to large wounds, contains a rich vascular and lymphatic supply, and allows containing infections and absorbing exudates. But additional procedures for patients with serious infection can be highly invasive and life-threatening. Harvesting of the omental flap normally necessitates a formal laparotomy often in a high-risk patient, which is associated with significant morbidity and mortality. The laparoscopic approach has the potential to decrease the physiological stress of laparotomy, and high risk of abdominal wound infection and incisional hernia. The laparoscopically harvested omental flap is a less invasive and valuable technique, and seems to offer a safe procedure in the treatment of deep sternal wound infection.


Copyright © 2018, JAPAN SOCIETY FOR ENDOSCOPIC SURGERY All rights reserved.

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電子版ISSN 2186-6643 印刷版ISSN 1344-6703 日本内視鏡外科学会

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