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The Journal of Thoracic and Cardiovascular Surgery, Vol 95, 677-684, Copyright © 1988 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
DJ Mathisen, HC Grillo, GJ Vlahakes and WM Daggett
The pedicled omentum finds use in cardiothoracic surgery for management of
complicated problems and prevention of serious complications. Its blood
supply is excellent and is capable of inducing neovascularity. Based on the
right gastroepiploic artery, it reaches anywhere in the thorax or neck. Its
bulk helps to fill infected spaces. Thirty-seven patients have been treated
with the pedicled omentum. In 16 patients the goal was preventive, to avoid
bleeding, anastomotic leakage, or infection or to provide a source of
fibroplasia or neovascularity. In eight patients with cervical exenteration
the flap protected against innominate artery erosion and esophageal
leakage, generally in an irradiated field. In six patients it permitted
primary healing of heavily irradiated trachea--formerly unlikely. It was
also used to provide coverage of a chest wall prosthesis in two patients.
In 21 patients the omentum was used to obtain healing in the presence of
infection. Bronchopleural fistulas were successfully closed in eight of
nine patients. Six mediastinal infections that developed after cardiac
operations were successfully treated. Four unusual vascular infections
necessitated the use of omentum. Two patients had closure of esophageal
perforations buttressed with omentum. This series demonstrates the efficacy
of the omentum in the management of complex cardiac, vascular, esophageal,
tracheal, bronchial, pleural, and chest wall problems.
ARTICLES
The omentum in the management of complicated cardiothoracic problems
General Thoracic Surgical Unit, Massachusetts General Hospital, Boston 02114.
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