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Severe descending necrotizing mediastinitis: vacuum-assisted dressing did wonder

Abstract

Descending necrotizing mediastinitis (DNM) is a rapidly progressive disease from the spread of cervical infection. Transcervical and transthoracic drainage was the recognized traditional surgical approach to achieve adequate clearance of infection. Non-invasive vacuum-assisted dressing is a new technique where applied negative pressure can help remove infective fluid and to promote wound healing. A 60-year-old man presented with odynophagia, fever and anterior neck swelling for 2 weeks. He was diagnosed to have anterior neck abscess and underwent surgical drainage. However, it did not respond well, but progressed to involve superior and inferior mediastinum. Vacuum-assisted dressing was applied for total of 2 weeks and the patient recovered without going through usual traditional transthoracic drainage. Vacuum drainage is a simple, safe and non-invasive method of managing DNM, in well selected group with small abscess cavity without airway obstruction and septicemia. This potential technique can lead to paradigm shift in treating life-threatening DNM.

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References

  1. 1.

    Estrera AS, Landay MJ, Grisham JM, Sinn DP, Platt MR. Descending necrotizing mediastinitis. Surg Gynecol Obstet. 1983;157:545–52.

  2. 2.

    Islam A, Oko M. Cervical necrotising fasciitis and descending mediastinitis secondary to unilateral tonsillitis: a case report. J Med Case Rep. 2008;2:368.

  3. 3.

    Liptay MJ, Fry WA, Shields TW. Acute and chronic mediastinal infections. In: Shields TW, LoCicero J, Ponn RB, editors. Shields general thoracic surgery. Philadelphia: Lippincott Williams and Willkins; 2000. p. 2093–104.

  4. 4.

    Ely WE, Stump TE, Hudspeth AS, et al. Thoracic complications of the dental surgical procedures: hazards of the dental drill. Am J Med. 1983;95:456–65.

  5. 5.

    Wang LF, Kuo WR, Tsai SM, Huang KJ. Characterizations of life-threaten- ing deep cervical space infections: a review of one hundred ninety-six cases. Am J Otolaryngol. 2003;24:111–7.

  6. 6.

    Corsten MJ, Shamji FM, Odell PF, et al. Optimal treatment of descending necrotizing mediastinitis. Thorax. 1997;52:702–8.

  7. 7.

    Singhal P, Kejriwal N, Lin Z, et al. Optimal surgical management of descending necrotizing mediastinitis: our experience and review of the literature. Heart Lung Circ. 2008;17:124–8.

  8. 8.

    Roberts JR, Smythe WR, Weber RW, et al. Thoracoscopic management of descending necrotizing mediastinitis. Chest. 1997;112:850–4.

  9. 9.

    Inoue Yoshimasa, Gika Masatoshi, Nozawa Keijiro, et al. Optimum drainage method in descending necrotizing mediastinitis. Interact Cardiovasc Thorac Surg. 2005;4:189–92.

  10. 10.

    Batacchi S, Matano S, Nella A, et al. Vacuum-assisted closure device enhances recovery of critically ill patients following emergency surgical procedures. Crit Care. 2009;13:194.

  11. 11.

    Perez D, Wildi S, Demartines N, Bramkamp M, Koehler C, Clavien PA. Prospective evaluation of vacuum-assisted closure in abdominal compartment syndrome and severe abdominal sepsis. J Am Coll Surg. 2007;205:586–92.

  12. 12.

    Gallo Oreste, Deganello Alberto, Meccariello Giuseppe, et al. Vacuum-assisted closure for managing neck abscesses involving the mediastinum. Laryngoscope. 2012;122:785–8.

  13. 13.

    Deniz Hayati, Gokaslan Gokhan, Arslanoglu Yavuz, et al. Treatment outcomes of postoperative mediastinitis in cardiac surgery; negative pressure wound therapy versus conventional treatment. J Cardiothorac Surg. 2012;7:67.

  14. 14.

    Freeman RK, Vallieres E, Verrier ED, Karmy-Jones R, Wood DE. Descending necrotizing mediastinitis: an analysis of the effects of serial surgical debridement on patient mortality. J Thorac Cardiovasc Surg. 2000;119:260–7.

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Correspondence to Y. T. Liew.

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All the authors have declared no competing interest.

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Liew, Y.T., Lim, E.Y.L., Zulkiflee, A.B. et al. Severe descending necrotizing mediastinitis: vacuum-assisted dressing did wonder. Gen Thorac Cardiovasc Surg 65, 225–228 (2017). https://doi.org/10.1007/s11748-016-0642-3

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Keywords

  • Descending necrotizing mediastinitis
  • Transthoracic
  • Vacuum-assisted dressing