Descending necrotizing mediastinitis treated with rapid sternotomy followed by vacuum-assisted therapy.
BACKGROUND
Descending necrotizing mediastinitis (DNM) is a life-threatening emergency after oropharyngeal infection. The diagnosis must be established rapidly. DNM is associated with septic shock and respiratory insufficiency. Because mortality rates may be as high as 60%, aggressive surgical treatment is indicated.


METHODS
Between December 2001 and December 2005, 5 patients (3 men, 2 women) with DNM, average age of 69 years (range, 24 to 72 years), were treated at our department. Surgical treatment consisted of one or more cervical drainages and drainage of the mediastinum through sternotomy after mediastinitis had been confirmed by computed tomography. The latter investigation also revealed mediastinal abscess and empyema. After radical debridement, a vacuum-assisted closure device was inserted.


RESULTS
The outcome was favorable in 4 patients. A 72-year-old woman died of prolonged septic shock and subsequent multiple organ failure. Tracheotomy was performed in all patients to create an airway. The duration of the intensive care unit stay was 51 +/- 24.2 days.


CONCLUSIONS
Rapid and extensive cervical and mediastinal debridement is mandatory in patients with DNM. A vacuum-assisted closure device is useful because it promotes tissue approximation and stimulates the ingrowth of granulation tissue.
Gorlitzer
Michael
M
Department of Cardiovascular Surgery, Hospital Hietzing, Vienna, Austria. michael.gorlitzer@wienkav.at
Grabenwoeger
Martin
M
Meinhart
Johann
J
Swoboda
Herwig
H
Oczenski
Wolfgang
W
Fiegl
Nikolaus
N
Waldenberger
Ferdinand
F
D000038:Abscess / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery; D000328:Adult; D000368:Aged; D001424:Bacterial Infections; D003646:Debridement; D004322:Drainage; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008480:Mediastinitis / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D009336:Necrosis; D009960:Oropharynx / Q000382:microbiology; D013249:Sternum / Q000601:surgery*; D053831:Surgical Fixation Devices; D014057:Tomography, X-Ray Computed; D014140:Tracheotomy; D014618:Vacuum