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Nick Spindler,1 Christian D Etz,2 Martin Misfeld,2 Christoph Josten,1 Friedrich-Wilhelm Mohr,2 Stefan Langer1 1Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, 2Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Leipzig, Germany Introduction: Deep sternal wound infections (DSWIs) are rare but devastating complication after median sternotomy following cardiac surgery. Especially in the presence of artificial material or inadequate preliminary muscle flaps, the pedicled omentum flap is due to its immunological properties, the predetermined flap in salvage procedures. Methods: We treated 14 patients suffering a mediastinitis and open thorax using a pedicled omentoplasty as a salvage procedure because of persisting DSWIs. Omentoplasty was performed in combination with a split skin graft and the wound was closed by a vacuum-assisted therapy for 7 days. The patients’ sex and comorbid risk factors supporting DSWIs as well as the postoperative complications were recorded.Results: Retrospective analysis of 14 patients (10 males and four females) after a follow-up time of 24 months was performed. The average age was 75 years (range: 67–83). Heart surgery took place electively in eight cases, in three cases urgently and three for emergency reasons. The preoperative Euro Score was 16 (range 3.51–42.58). We had no flap loss in any patients. The skin graft showed a full take in all patients. Two patients needed revision of an abdominal wound dehiscence after laparotomy and one patient developed hernia in the late outcome.Discussion: The greater omentum flap has, over many years, become an ideal partner in the coverage and treatment of DSWIs. Especially due to its immunologic capacity and amorphous structure, it has the ability to fill up cavities and cover infected artificial material so residual infections can be controlled. Keywords: deep sternal wound infection, omentum flap, reconstruction of the thorax, mediastinitis, DSWI

This article compares the long-term outcomes of two different strategies for coronary revascularization: conventional off-pump total arterial revascularization with bilateral internal mammary arteries (BIMA) and hybrid coronary revascularization (HCR). The study retrospectively analyzed patients who received either BIMA (n = 542) or HCR (n = 123) at a single institute. After adjusting for baseline differences, the study found that patients who received BIMA had better 10-year survival and freedom from repeat revascularization compared to those who received HCR. However, the HCR group had a higher incidence of chronic obstructive lung disease, while the BIMA group had a higher incidence of three-vessel coronary artery disease and left main disease. Overall, the study suggests that for otherwise fit patients, conventional off-pump revascularization with BIMA may be the preferred strategy. [Extracted from the article]

This article discusses the use of Minimal Invasive Total Arterial Coronary Artery Bypass Grafting (MICS-CABG) as a surgical approach for treating coronary artery disease in obese patients. The study compared the outcomes of MICS-CABG in obese (BMI >30) and nonobese (BMI<30) patients. The results showed that MICS-CABG is safe and feasible for both obese and nonobese patients, with no significant differences in perioperative and mid-term outcomes. The authors conclude that obesity should not be an exclusion criterion for MICS-CABG in high volume centers. [Extracted from the article]

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