Sternal wound infection and chest wall reconstruction are challenging problems in surgery. Various treatments have been proposed including omental flaps. Traditionally, it has been harvested via laparotomy. We report on a case performed successfully via the laparoscopic approach in a patient with multiple wounds.

The patient is a 61 year old male with splenic myelofibrosis status post CABG. His postoperative course was notable for Klebsiella pneumonia and acalculous cholecystitis. He underwent placement of a tracheostomy, IVC filter, percutaneous gastrostomy, and cholecystostomy tube. On POD #60, a sternal abscess and osteomyelitis were recognized. After initial debridement, he underwent laparoscopic harvest of an omental flap, sternal wound reconstruction, and skin graft. Findings at surgery were adhesions to the G-tube tract and spleen secondary to myelofibrosis. However, there was adequate omentum to reconstruct the chest defect.

Laparoscopic omental flap harvest has been previously described but not in patients with previous abdominal surgeries or active abdominal disease such as cholecystitis, myelofibrosis, and the presence of a gastrostomy tube. Even though the omentum was adherent to the spleen secondary to meylofibrosis, we were impressed by the quality and ease of the graft harvest. The omentum represents a good alternative for chest wound reconstruction and provides a rich vascular, lymphatic supply with immunological roperties, adapts easily to large defects, and provides a good bed for skin graft uptake.

Laparoscopic harvest of omental flap for reconstructive procedures can be attempted even in the presence of concomitant intra-abdominal pathology and adhesions.