This video highlights the technical steps in creation of an omental flap for management of sternal dehiscence.

Sternal dehiscence is associated with a high mortality rate. The greater omentum seems to be the ideal tissue due to its vascularity, high lymphatic content, its long pedicle, large bulk and malleability. There are four key components in flap creation. First is colo-epiploic detachment of the omentum along an avascular plane, followed by division of anastomotic branches between Barkow's and gas flap is then mobilized from its gastric attachments pedicled on rt. gastro-epiploic artery. It is then transposed into the mediastinum.

A morbidly obese male developed sternal wound infection after five-vessel bypass using both internal mammary vessels. He underwent two unsuccessful sternal debridements and developed mediastinitis.

Omental flap was created and transposed into the mediastinum where it was placed over the heart and skin closed over it.

The patient did well and on follow up the overlying skin has completely healed.

This video highlights that laparoscopic omental flap creation can be safely done even in morbidly obese patients with multiple co-morbidities. This approach may provide advantages over an open approach and possibly widen indications for use of omental flaps.