Background: The greater omentum is easily harvested for coverage of sternal wounds without muscle sacrifice. Its major disadvantage is a laparotomy incision with potential bowel injury, adhesions, or hernia. Over the past 20 years, the authors' technique has evolved to use a transdiaphragmatic opening for omental harvest when possible.
Methods: The authors performed a retrospective cohort analysis of 140 consecutive patients undergoing omental flap harvest for treatment of sternal wounds following median sternotomy. Patients were divided into two groups by access incision: laparotomy incision (n = 80) versus a transdiaphragmatic opening (n = 60).
Results: The authors found that both techniques provided reliable closure of sternal wounds, but the transdiaphragmatic approach was faster, with less blood loss. There was no significant difference in rates of ventral hernias. We had only one bowel injury (laparotomy group) and no postoperative abdominal bleeding or small bowel obstruction.
Conclusion: Transdiaphragmatic omental harvest provides safe and efficient coverage of deep sternal wounds without a laparotomy incision.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
CODING PERSPECTIVE FOR THIS ARTICLE IS ON PAGE 551
From the Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School.
Received for publication November 22, 2011; accepted September 11, 2012.
Disclosure: The authors have no financial interest in any of the procedures or techniques discussed in this article. There are no conflicts of interest with the data provided and analyzed in this study.
Dennis P. Orgill, M.D., Ph.D.; Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, Mass. 02115, firstname.lastname@example.org