Laparoscopic Harvest of Omental Flaps for Reconstruction of Complex Mediastinal Wounds

BACKGROUND: Omental harvest for complex poststernotomy mediastinal wounds has traditionally required a formal laparotomy in often high-risk patients, thus making it the procedure of last resort. METHODS: The charts of all patients who underwent a laparoscopic omental harvest at the Texas Endosurgery Institute were retrospectively reviewed. RESULTS: Seven patients, 4 males and 3 females with an average age of 65.1±6.3 years, with complex mediastinal wounds following coronary artery bypass grafting were studied. All patients underwent laparoscopic harvest of omental flaps based on the right gastroepiploic artery (3), the left gastroepiploic artery (1) or both (3), along with pectoralis major myocutaneous advancement flaps in 5 patients and partial-thickness skin graft and a vacuum-assisted closure device in 2 patients. The average operative time for the entire procedure was 196±54 minutes. Enteric feedings could be tolerated early postoperatively with a mean of 3.8 days. One death (14.2%) occurred. All surviving patients had excellent wound healing results at a mean follow-up of 19.1 months. CONCLUSION: Laparoscopic harvest of omental flaps for the reconstruction of complex mediastinal wounds is a valid and potentially less morbid alternative for the treatment of this infrequent but disastrous complication of open heart surgery.