Severe descending necrotizing mediastinitis: vacuum-assisted dressing did wonder


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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Correspondence to Y. T. Liew.

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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).

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  • Descending necrotizing mediastinitis
  • Transthoracic
  • Vacuum-assisted dressing