Lovich et al. described their experience of 20 patients with postcardiotomy sternal wound infections 17 of whom underwent omental pedicle grafts with excellent results. A left subcostal incision began to be used for omental harvesting to avoid incisional hernia towards the later part of their practice [
49]. Brabendare et al. reported good functional and aesthetic results in 6 consecutive patients with laparoscopically harvested omentoplasty in combination with prior negative wound cultures achieved with repeated wound debridements, antibiotics and negative pressure wound therapy (NPWT), supplemented by bilateral pectoralis major advancement flaps [
50]. Acarturk emphasised the large size and bulk of omental flaps to fill 3-dimensional dead spaces and the advantages of their large pedicles and rich vascular and lymphatic networks. Out of 9 laparoscopic omental harvests, 7 were used for reconstruction of infection related sternal wound complications and 2 for repair of intrathoracic viscera with excellent results, apart from one transdaiphragmatic hernia treated laparoscopically [
51]. Levites et al. described sternal wound reconstruction with falciform and omental flaps for chronic sternal osteomyelitis (42A). Salameh et al. treated 7 complex mediastinal wounds with omental flaps based on right gastroepiploic artey [
3], left gastroepiploic artery [
1] or both [
3] along with 5 bilateral pectoralis major myocutaneous advancement flaps with good results [
52]. Schroeyers et al. after disappointing results with conservative management of post-CABG mediastinitis, treated 32 patients with combination of only omentoplasty (
n = 11), a single pectoralis major flap and omentoplasty (
n = 20) and bilateral pectoral flaps only (n = 1) with no early or late flap failures [
53]. Milano et al. compared 21 isolated omental flaps and 38 pectoral flaps for poststernotomy mediastinits and found omental flaps had improved early outcomes with no late flap failures and were more effective therapy relative to pectoral flaps [
54]. Parissis et al. reported on the outcomes and risk analysis of DSWIs with specific emphasis on omental transposition in a large series of 3896 cardiac surgical patients with 120 wound infections (3.02%) out of which 52 (1.34%) had DSWIs. Diabetes, renal dysfunction and prolonged mechanical ventilation were the commonest risk factors for DSWIs. Overall mortality was 9.3% and the mortality for the omental group was 8.3% with a mean hospital stay of 59 days [
55]. Pieri et al. reported on a higher incidence of medistinitis in patients who underwent implanatable ventricular assist devices (VAD) and the role of well-vascularised and immune active omental flaps after aggressive debridement and NPWT in this selective group. There was a 47% survival, with postoperative renal failure requiring dialysis and septic shock requiring vasopressors the greatest risk factors for death [
56]. Dorseifer et al. looked beyond the pedicled local and regional grafts and arteriovenous microsurgical loops and reported 12 patients with DSWIs who underwent gracilis (
n = 8) and anterolateral thigh perforator free flaps (
n = 4) anastomosed to the right gastroepiploic vessels harvested in 42% patients laparoscopically with uneventful healing [
57]. Kaul et al. described a chronic encapsulated anterior mediastinal abscess presenting with remote cutaneous fistulisation 12 years after redo aortic valve replacement for prosthetic valve endocarditis. The abscess cavity was excised and the thin posterior rim of the cavity which formed the anterior wall of ascending aorta was covered with right gastroepiploic artery based pedicled omental flap [
58]. Omental flaps may be the seat of secondaries from a primary cancer and Telfer et al. reported metastatic colonic adenocarcinoma in a pedicled omental flap used for sternal reconstruction [
59].