Journal Information
Vol. 44. Issue 2.
Pages 113-115 (January 2008)
Share
Share
Download PDF
More article options
Vol. 44. Issue 2.
Pages 113-115 (January 2008)
Case Reports
Full text access
Utility of Omentoplasty for Poststernotomy Mediastinitis Secondary to Myocardial Revascularization Surgery
Visits
5828
Jorge Quiroga Martíneza,
Corresponding author
quirojo@hotmail.com

Correspondence: Dr J Quiroga Martínez Servicio de Cirugía Torácica, Hospital Clínico Universitario Ramón y Cajal3;47005 Valladolid, Spain
, Javier Gualis Cardonab, Begoña Gregorio Crespoa, Sara Cabanyes Candelaa, Ángel Cilleruelo Ramosa, José Luis Duque Medinaa
a Servicio de Cirugía Torácica, Hospital Clínico Universitario, Valladolid, Spain
b Servicio de Cirugía Cardiovascular, Hospital Clínico Universitario, Valladolid, Spain
This item has received
Article information

Acute poststernotomy mediastinitis is a serious complication of cardiac surgery and is associated with high mortality. Conservative treatment with local debridement, irrigatingsuction systems, and specific antibiotic therapy is sometimes inadequate.

Omentoplasty is occasionally used for reconstruction and the treatment of various chest diseases. This useful procedure is most often indicated for suppurative processes and radionecrosis, to complement myoplasty, or to cover a chest wall prosthesis. When used to treat poststernotomy mediastinitis secondary to cardiac surgery, omentoplasty improves control of infection and prognosis.

We describe 2 cases of poststernotomy mediastinitis secondary to cardiac revascularization surgery in which omentoplasty was an effective treatment. Excellent control of infection was achieved.

Key words:
Omentoplasty
Poststernotomy mediastinitis
Hanuman syndrome
Cardiac surgery

Utilidad de la omentoplastia en el tratamiento de la esternomediastinitis secundaria a cirugía de revascularización miocárdica

La esternomediastinitis aguda es una complicación grave que puede aparecer tras intervenciones de cirugía cardíaca y que presenta una elevada mortalidad. El tratamiento conservador mediante curas locales, sistemas de drenaje-lavado y uso de antibióticos específicos es a veces insuficiente.

La omentoplastia, ocasionalmente utilizada en la reconstrucción y tratamiento de diferentes enfermedades torácicas, es un procedimiento útil, que tiene su mayor indicación en procesos supurativos, radionecrosis, complemento a mioplastias y protección de prótesis de pared torácica. Su utilización en el tratamiento de la esternomediastinitis secundaria a cirugía cardíaca ayuda al control de la infección y mejora la evolución de los pacientes.

Presentamos 2 casos de esternomediastinitis secundaria a cirugía de revascularización miocárdica en los que la omentoplastia ha sido un tratamiento efectivo, consiguiendo excelentes resultados en el control de la infección.

Palabras clave:
Omentoplastia
Esternomediastinitis
Síndrome de Hanuman
Cirugía cardíaca
Full text is only aviable in PDF
References
[1]
P Schroeyers, F Wellens, I Degrieck, R De Geest, F Van Praet, Y Vermuelen, et al.
Aggressive primary treatment for poststernotomy acute mediastinitis: our experience with omental-and muscle flaps surgery.
Eur J Cardiothorac Surg, 20 (2001), pp. 743-746
[2]
QX Zhang, CJ Magovern, CA Mack, KT Budenbender, W Ko, TK Rosengart.
Vascular endothelial growth factor is the major angiogenic factor in omentum: mechanism of the omentum-mediated angiogenesis.
J Surg Res, 67 (1997), pp. 147-154
[3]
CS Hultman, GW Carlson, A Losken, G Jones, J Culbertson, G Mackay, et al.
Utility of the omentum in the reconstruction of complex extraperitoneal wounds and defects: donor-site complications in 135 patients from 1975 to 2000.
Ann Surg, 235 (2002), pp. 782-795
[4]
L O'Shaughnessy.
Surgical treatment of cardiac ischaemia.
Lancet, 1 (1937), pp. 185
[5]
SA Thompson, B Pollock.
The use of free omental grafts in the thorax: an experimental study.
Am J Surg, 70 (1945), pp. 227
[6]
YN Levashev, AL Akopov, IV Mosin.
The possibilities of greater omentum usage in thoracic surgery.
Eur J Cardiothorac Surg, 15 (1999), pp. 465-468
[7]
G Jones, MJ Jurkiewicz, J Bostwick, R Wood, JT Bried, J Culbertson, et al.
Management of the infected median sternotomy wound with muscle flaps. The Emory 20-year experience.
Ann Surg, 225 (1997), pp. 766-778
[8]
A Lappa, MR Malpieri, M Cicco, A Bucci, M Malpieri, F Araimo, et al.
An alternative inexpensive treatment for deep sternal wound infections after sternotomy.
Interactive Cardiovascular and Thoracic Surgery, 2 (2003), pp. 629-632
[9]
DE Allie, CJ Hebert, MD Lirtzman, CH Wyatt, VA Keller, SM Souther, et al.
Novel treatment strategy for leg and sternal wound complications after coronary artery bypass graft surgery: bioengineered Apligraf.
Ann Thorac Surg, 78 (2004), pp. 673-678
[10]
C Brandt, JM Álvarez.
First-line treatment of deep sternal infection by a plastic surgical approach: superior results compared with conventional cardiac surgical orthodoxy.
Plast Reconstr Surg, 109 (2002), pp. 2231-2237
[11]
R Wettstein, D Erni, P Berdat, D Rothenfluh, A Banic.
Radical sternectomy and primary musculocutaneous flap reconstruction to control sternal osteitis.
J Thorac Cardiovasc Surg, 123 (2002), pp. 1185-1190
[12]
T Krabatsch, E Fleck, R Hetzer.
Treating poststernotomy mediastinitis by transposition of the greater omentum: late angiographic findings.
J Card Surg, 10 (1995), pp. 46-51
[13]
H López-Monjardin, A de la Peña-Salcedo, M Mendoza-Muñoz, A López-Yáñez de la Peña, E Palacio-López, A López-García.
Omentum flap versus pectoralis major flap in the treatment of mediastinitis.
Plast Reconstr Surg, 101 (1998), pp. 1481-1485
[14]
F Puma, C Fedeli, P Ottavi, G Porcaro, G Battista Fonsi, A Pardini, et al.
Laparoscopic omental flap for the treatment of major sternal wound infection after cardiac surgery.
J Thorac Cardiovasc Surg, 126 (2003), pp. 1998-2002
Copyright © 2008. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
Archivos de Bronconeumología
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?