Reconstruction of Infected Mediastinal Wound with an Omental Flap Harvested Laparoscopically After Cardiac Surgery: Report of Two Cases and Literature Review

Abstract

BACKGROUND: Deep sternal wound infection and dehiscence are two serious complications after open cardiac surgery. Omental flap harvesting is recognized as one of the management options, with traditionally non-favorable outcomes due to laparotomy stress on patients. OBJECTIVE: Herein, however, we report our experience with two patients who have developed a mediastinal wound infection following coronary artery bypass grafting and were reconstructed with omental flaps harvested laparoscopically. CASE PRESENTATION: Two 74-year-old females, who were known to have multiple comorbidities, developed a sternal wound infection after coronary artery bypass graft. Several operative trials and non-operative measures have been attempted to manage the infections and/or reconstruct the wound but failed. Both patients then underwent laparoscopic omental flap harvesting for reconstruction and exhibited significant clinical improvement postoperatively. DISCUSSION: Omental flap is considered a feasible option for reconstruction of sternal wound dehiscence developing after open cardiac surgery because it is usually well-vascularized, contains a large number of immunologically active cells and has the ability to absorb wound secretions. The traditional method of harvesting is conventional laparotomy, but it carries high rates of morbidity. Therefore, laparoscopic harvesting can be utilized as an alternative with better outcomes. CONCLUSION: Laparoscopic omental flap harvesting is considered a feasible and safe procedure to manage sternal wound dehiscence after open cardiac surgery, with satisfactory surgical outcomes.