Tebala Giovanni Domenico, Ciani Renzo, Fonsi Giovanni Battista, Hadjiamiri Hossein, Barone Paolo, Di Pietrantonio Pietro, Zumbo Antonella
Laparoendoscopic Unit, Aurelia Hospital, Rome, Italy.
J Laparoendosc Adv Surg Tech A. 2006 Apr;16(2):141-5. doi: 10.1089/lap.2006.16.141.
Sternotomy dehiscence is associated with a high mortality rate. In most cases this complication may be treated by simple debridement and antibiotic therapy, but sometimes it is necessary to fill the sternal defect with viable tissue. The greater omentum seems to be the ideal tissue to be transposed because of its malleability, good vascularization, and high lymphatic tissue content. The transposition of the greater omentum usually requires a midline laparotomy for the preparation of the flap, with significant laparotomy-related morbidity. Laparoscopic access may represent an effective alternative for preparing and transposing the omental flap. The key points of the laparoscopic technique are (1) the coloepiploic detachment, (2) the section of the anastomotic arterial branches between the Barkow's arcade and the gastroepiploic arcade, (3) the mobilization of the greater omentum pedicled on the right gastroepiploic artery, and (4) its transposition into the mediastinum, taking care to avoid twisting the gastric greater curvature and the flap itself.
胸骨切开术裂开与高死亡率相关。在大多数情况下，这种并发症可通过简单的清创术和抗生素治疗来处理，但有时需要用有活力的组织填充胸骨缺损。大网膜因其柔韧性、良好的血管化和高淋巴组织含量，似乎是理想的可转移组织。大网膜转移通常需要经中线剖腹术来制备皮瓣，这会带来与剖腹术相关的显著发病率。腹腔镜入路可能是制备和转移网膜瓣的有效替代方法。腹腔镜技术的关键点包括：（1）结肠网膜分离；（2）切断巴尔科夫弓与胃网膜弓之间的吻合动脉分支；（3）以胃网膜右动脉为蒂游离大网膜；（4）将其转移至纵隔，注意避免胃大弯和皮瓣本身扭转。
