4. Comparison of Omental and Pectoralis Flaps for Poststernotomy Mediastinitis
Carmelo A. Milano, Peter K. Smith, Gregory S. Georgiade, Walter G. Wolfe
Duke University Medical Center
Durham, N.C.
The pectoralis muscle is commonly employed
as a soft tissue flap for treatment of post-sternotomy mediastinitis. Transfer
of the omentum represents an alternative treatment. Twenty-one consecutive
patients treated with omental flaps were retrospectively compared to 38
consecutive patients treated with pectoralis flaps for post-sternotomy
mediastinitis. All patients were treated as a single institution and follow-up,
consisting of clinic visits and telephone surveys, was obtained on 95 percent
of patients. Outcomes are shown below:
|
Variable |
Omental flap (21) | Pectoralis flap (38) | p value |
| OR time (min) | 221±87 | 284±67 | p<0.05 |
| Mortality | 4.7% | 10.5% | NS |
| length of post-op hospitalization (days) | 10.7±6 | 18.8±12 | p<0.05 |
The omental flap group had significantly fewer early complications (two), compared to the pectoralis flap group (10); 9.5 percent vs 27.7 percent, p<0.05. Furthermore, the pectoralis flap group has five late chest abscesses including one late flap failure; there were no early or late flap failures or abscesses in the patients with omental flaps. This retrospective comparison suggests that omental flaps may have improved outcomes and may be cost effective for treatment of post-sternotomy mediastinitis.