Conventional open surgery versus percutaneous catheter drainage in the treatment of cervical necrotizing fasciitis and descending necrotizing mediastinitis.
OBJECTIVE
The purpose of our study was to determine the clinical usefulness of percutaneous catheter drainage compared with conventional surgical drainage for cervical necrotizing fasciitis and descending necrotizing mediastinitis. SUBJECTS AND METHODS. Thirty-one patients with cervical necrotizing fasciitis and descending necrotizing mediastinitis were included. Twenty consecutive patients were treated by percutaneous catheter drainage. Catheters were introduced into the infected space from the neck, under the guidance of sonography and X-ray fluoroscopy. The results of the treatment were compared with those of 11 patients treated previously by surgical drainage.


RESULTS
In the catheter group, no patient required supplementary surgical drainage. Mortality was 0% in both groups. Comparison of length of stay in the ICU, serial changes in C-reactive protein levels, duration of antibiotic therapy, and duration of mechanical ventilation all showed no statistically significant difference between groups. Secondary infection of the wound and positive culture of antibiotic-resistant bacteria were observed less frequently in the catheter group than in the open surgical group. The total use of plasma infusion and analgesics was significantly less in the catheter group than in the surgery group. Oral feeding was started significantly earlier in the catheter group than in the surgery group.


CONCLUSIONS
Percutaneous catheter drainage for cervical necrotizing fasciitis and descending necrotizing mediastinitis was less invasive than conventional surgical drainage but produced a similar outcome.
Nakamori
Yasushi
Y
Department of Traumatology, Osaka University Medical School, 2-15 Yamadaoka, Suita-shi, Osaka 565-0871, Japan. nakamori@hp-emerg.med.osaka-u.ac.jp
Fujimi
Satoshi
S
Ogura
Hiroshi
H
Kuwagata
Yasuyuki
Y
Tanaka
Hiroshi
H
Shimazu
Takeshi
T
Ueda
Toshio
T
Sugimoto
Hisashi
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization; D004322:Drainage; D019115:Fasciitis, Necrotizing / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D009333:Neck; D009336:Necrosis; D013514:Surgical Procedures, Operative