Thoracic transposition of the greater omentum as an adjunct in the treatment of mediastinitis--pros and cons within the context of a randomised study.

Mediastinitis after cardiac surgery is a rare but life-threatening complication. The omentum is particularly well-suited for the treatment of severe sternal wound infections, because it contains large numbers of immunologically active cells that seem to be responsible for the high anti-infective activity of the omentum. The additional transposition of parts of the greater omentum into the thorax was discussed in the development of a protocol for the planned ATMI study, which will investigate the effectiveness of immunoglobulins in the treatment of severe sternal wound infections that require reoperation. We present two different points of view about whether omentopexy should be allowed within the study design.