Early to midterm survival of patients with deep sternal wound infection managed with laparoscopically harvested omentum.

Publisher: Wiley-Blackwell Country of Publication: United States NLM ID: 8908809 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1540-8191 (Electronic) Linking ISSN: 08860440 NLM ISO Abbreviation: J Card Surg Subsets: MEDLINE

Publication: Hoboken, NJ : Wiley-Blackwell
Original Publication: Mount Kisco, N.Y. : Futura Pub. Co., Inc., [c1986-

Omentum*/surgery ; Surgical Wound Infection*; Adult ; Aged ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Sternotomy ; Sternum/surgery

Objective: The optimal management of deep sternal wound infection (DWSI) remains controversial. Our objective was to evaluate outcomes of patients with DSWI managed with transposition of laparoscopically harvested omentum (LHO).
Methods: Between 2000 and 2020, a total of 38,623 adult patients who underwent full median sternotomy for cardiac surgery were analyzed retrospectively at our institution. DSWI occurred in 455 (1.2%), of whom 364 (93.2%) were managed with pectoralis myocutaneous flap (PMF) and 33 (7.2%) with LHO. Univariate and multivariate analysis models were used to determine predictors of cumulative late mortality and adjusted survival curves were generated.
Results: Among patients who received LHO, average age was 65.7 ± 9.7 years and a larger proportion of patients were male. A majority of patients (88%) had coronary bypass surgery, with bilateral internal mammary arteries use in only 21.2%. Mean length of stay (LOS) was 58.90 days and early hospital mortality occurred in 4 patients (12.1%). Patients who received LHO compared to only PMF had larger body mass index and had more heart failure. Furthermore, the hospital LOS was also significantly prolonged in the LHO group (58.9 vs. 27.4 days, p = .002), with a slightly higher in-hospital mortality (12.1% vs. 3.3%, p = .03). Late survival for LHO patients at 5 and 10 years was 71.9% and 44.8%, respectively.
Conclusion: Use of LHO is a safe and viable alternative to traditional myocutaneous flaps to manage complex DSWI. Early and late survival were favorable in this high-risk population.
(© 2021 Wiley Periodicals LLC.)

Milano CA, Kesler K, Archibald N, Sexton DJ, Jones RH. Mediastinitis after coronary artery bypass graft surgery risk factors and long-term survival. Circulation. 1995;92(8):2245-2251.
Loop FD, Lytle BW, Cosgrove DM, et al. J. Maxwell Chamberlain memorial paper. Sternal wound complications after isolated coronary artery bypass grafting: early and late mortality, morbidity, and cost of care. Ann Thorac Surg. 1990;49(2):179-186.
Lonie S, Hallam J, Yii M, et al. Changes in the management of deep sternal wound infections: a 12-year review. ANZ J Surg. 2015;85(11):878-881.
Stone PW, Braccia D, Larson E. Systematic review of economic analyses of health care-associated infections. Am J Infect Control. 2005;33(9):501-509.
Jurkiewicz MJ, Bostwick J, Hester TR, Bishop JB, Craver J. Infected median sternotomy wound. Successful treatment by muscle flaps. Ann Surg. 1980;191(6):738-744.
Mathisen DJ, Grillo HC, Vlahakes GJ, Daggett WM. The omentum in the management of complicated cardiothoracic problems. J Thorac Cardiovasc Surg. 1988;95(4):677-684.
Jurkiewicz MJ, Arnold PG. The omentum: an account of its use in the reconstruction of the chest wall. Ann Surg. 1977;185(5):548-554.
Lee AB Jr, Schimert G, Shaktin S, Seigel JH. Total excision of the sternum and thoracic pedicle transposition of the greater omentum; useful strategems in managing severe mediastinal infection following open heart surgery. Surgery. 1976;80(4):433-436.
Baillot R, Cloutier D, Montalin L, et al. Impact of deep sternal wound infection management with vacuum-assisted closure therapy followed by sternal osteosynthesis: a 15-year review of 23,499 sternotomies. Eur J Cardiothorac Surg. 2010;37(4):880-887.
Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections. Am J Infect Control. 1988;16(3):128-140.
Tomos P, Lachanas E, Michail PO, Kostakis A. Alternative bi-pectoral muscle flaps for postoperative sternotomy mediastinitis. Ann Thorac Surg. 2006;81(2):754-755.
Konofaos P, Spartalis E, Karagkiouzis G, Kampolis C, Tomos P. An alternative technique for surgical management of poststernotomy osteomyelitis and reconstruction of the sternal defect. Case Rep Surg. 2013;2013:451594-451594.
Spindler N, Etz CD, Misfeld M, Josten C, Mohr FW, Langer S. Omentum flap as a salvage procedure in deep sternal wound infection. Ther Clin Risk Manag. 2017;13:1077-1083.
Puma F, Fedeli C, Ottavi P, et al. Laparoscopic omental flap for the treatment of major sternal wound infection after cardiac surgery. J Thorac Cardiovasc Surg. 2003;126(6):1998-2002.
van Wingerden JJ, Coret ME, van Nieuwenhoven CA, Totté ER. The laparoscopically harvested omental flap for deep sternal wound infection. Eur J Cardiothorac Surg. 2010;37(1):87-92.
Toumpoulis IK, Anagnostopoulos CE, Derose JJ Jr, Swistel DG. The impact of deep sternal wound infection on long-term survival after coronary artery bypass grafting. Chest. 2005;127(2):464-471.
Braxton JH, Marrin CA, McGrath PD, et al. 10-year follow-up of patients with and without mediastinitis. Semin Thorac Cardiovasc Surg. 2004;16(1):70-76.
Balachandran S, Lee A, Denehy L, et al. Risk factors for sternal complications after cardiac operations: a systematic review. Ann Thorac Surg. 2016;102(6):2109-2117.
Serry C, Bleck PC, Javid H, et al. Sternal wound complications. Management and results. J Thorac Cardiovasc Surg. 1980;80(6):861-867.
Baillot R, Cloutier D. Progress and Milestones in the Treatment of Deep Sternal Wound Infections, in Dawn and Evolution of Cardiac Procedures: Research Avenues in Cardiac Surgery and Interventional Cardiology. M. Picichè, Editor. Springer Milan: Milano; 2013:273-284.
Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg. 1997;38(6):553-562.
Gaudreau G, Costache V, Houde C, et al. Recurrent sternal infection following treatment with negative pressure wound therapy and titanium transverse plate fixation. Eur J Cardiothorac Surg. 2010;37(4):888-892.

Keywords: cardiovascular pathology; cardiovascular research

Date Created: 20210902 Date Completed: 20211004 Latest Revision: 20211004

20221213

10.1111/jocs.15955

34473370