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The Laparoscopic Omental Flap Revisited
Claire Oliver, Michael Subichin
Summa Health
2025-01-10
Presenter: Claire Oliver
Affidavit:
This is the original work of the resident.
Director Name: Ananth Murthy, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Deep sternal wound infection is an infrequent but devastating problem. Most commonly this occurs in the setting of cardiac surgery as a complication of median sternotomy or internal mammary harvest. These infections are frequently treated with debridement and coverage. To avoid laparotomy, omental flaps are generally reserved as a salvage treatment. With the advancements of laparoscopy and robotic surgery, minimally invasive omental harvest can be far more easily achieved. The use of omental flaps can allow a muscle-sparing flap and harness the immunologic and lymphatic properties of the omentum to obliterate dead space. Here we present a case series of sternal wound reconstruction using laparoscopic omental flaps as part of a first-line treatment for deep space sternal infections.
Methods: Reconstructions were performed in a single-stage consisting of radical debridement, hardware removal if present, laparoscopic-assisted omental flap, pectoralis flaps, and primary skin closure. Patient sex, comorbidities, and post-operative complications were recorded after a minimum 6 month follow up period.
Results: Three patients underwent omental flaps. There were no flap losses. No patients developed recurrent deep wound infections or recurrent osteomyelitis. Two patients developed superficial wounds requiring local wound care. One patient developed an asymptomatic ventral hernia.
Conclusion: Laparoscopic omental flaps are a valuable adjunct for treatment of deep sternal wound infections and the advancement of minimally invasive technology allow these flaps to be considered when faced with deep sternal infections
