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A Journal on Surgery

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Chirurgia 2009 August;22(4):183-8


language: English

The greater omentum’s transposition for the management of mediastinitis. The Hanuman Syndrome

Hountis P., Hatziveis K., Tourlakis D., Antonopoulos N., Kokotsakis I., Camoutsis C., Bolos K.

1 Cardiac Surgery Department, General Hospital “Evaggelismos”, Athens, Greece; 2 Laboratory of Pharmaceutical Chemistry, Departement of Pharmacy, Faculty of Pharmacy, School of Health Science, University of Patras, Greece; 3 Department of Obstetric and Gynaecology, General Hospital “Agios Andreas”, Patras, Greece


Aim. The aim of our study is to present our experience from the management of six patients with deep sternal wood infection and or sternal disruption and mediastinitis after aortocoronary by pass grafting. Sternal dehiscence and mediastinitis is a rare but highly lethal (40%) complication in cardiac surgery.
Methods. Five male patients 60-74 years old (mean 66) and a female 62 years old, obese, with a history of diabetes mellitus were subjected to aortocoronary by pass grafting due to ischemic heart disease. Postoperative course was initially uneventful. Mean time of sternal dehiscence and mediastinitis was 9-17 (mean 11) days. Intraoperatively, we performed a total sternectomy and with a small laparotomy we harvested greater omentum with the left gastrepiploic artery and we transposed it through diaphragm into the thorax.
Results. Mean ICU stay was 11 days (4-21). All patients had an uneventful postoperative course with a mean hospital stay of 28.6 days (20-46).
Conclusion. We believe that greater omentum is the ideal reconstruction tissue for deep sternal wound infections and mediastinitis. It contains a large number of immunological active cells that account for its antibacterial properties. Timely diagnisis, aggressive sternal debridement and omental flap coverage along with intravenous antibiotics represent the mainstay of therapy in this highly lethal complication.

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