title: Successfully treated descending necrotizing mediastinitis through thoracotomy using a pedicled muscular serratus anterior flap.
abstract: Descending necrotizing mediastinitis (DNM) is rare and aggressive. A 68-year-old female with no medical history, was admitted to our institution for cervical cellulitis. After a conventional medical treatment, multiple abscesses of the upper mediastinum appeared on computed tomography (CT) findings. Although two cervicotomies were performed, a new necrotic abscess appeared in the anterior upper and middle mediastinum. An extensive debridement of cellulitis and abscess extended to the pericardium was made by thoracotomy. Middle mediastinum and pericardium were covered and reconstructed by a right pedicled serratus anterior flap. After radical surgery, follow-up was uneventful. Early extensive and complete debridement of cervical and mediastinal collections and irrigation with broad-spectrum intravenous antibiotics is essential. Combined surgery is the best approach in DNM. The use of a pedicled muscular flap helps control the sepsis. In such cases, serratus anterior flap is a flap of choice because it is reliable and always available even in a skinny patient, contrary to omentum. In this life-threatening disease, an early aggressive combined surgery with debridement of all necrotic tissues extended to the pericardium if necessary associated with a pedicled flap is mandatory.
authors.affiliation: Department of Thoracic and Vascular Surgery, Amiens South Hospital, University of Picardie, Place Victor Pauchet, 80054 Amiens, Cedex 01, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Haremza
authors.forename: Florence
authors.initials: F
authors.lastname: De Dominicis
authors.forename: Geoni
authors.initials: G
authors.lastname: Merlusca
authors.forename: Pascal
authors.initials: P
authors.lastname: Berna
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D003646:Debridement; D005260:Female; D006801:Humans; D008480:Mediastinitis / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D008482:Mediastinum / Q000473:pathology / Q000601:surgery*; D018482:Muscle, Skeletal / Q000601:surgery*; D009336:Necrosis; D013524:Surgical Flaps; D007507:Therapeutic Irrigation; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents